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Trisomy of leukemic cell chromosomes 4 and 10 identifies children with
B-progenitor cell acute lymphoblastic leukemia with a very low risk of
treatment failure: a Pediatric Oncology Group study
MB Harris, JJ Shuster, A Carroll, AT Look, MJ Borowitz, WM Crist, R Nitschke, J Pullen, CP Steuber and VJ Land
Tomorrows Children's Institute, Hackensack Medical Center, NJ.
To account for the superior prognosis of hyperdiploid, B-progenitor acute
lymphoblastic leukemia (ALL), we investigated the influence of trisomy in
1021 children greater than or equal to 1 year old by recursive partitioning
analysis. The patients were treated according to a stratified, randomized
study testing antimetabolite-based therapies. Trisomies of several
individual chromosomes were associated with a better prognosis in a
univariate statistical analysis. Of greater importance, trisomy of both
chromosomes 4 and 10 identified a subgroup of patients (n = 180) with an
extremely favorable 4-year event-free survival (EFS). Combined trisomy of
chromosomes 4 and 10 retained its prognostic significance after
stratification of patients by DNA index, age, and leukocyte count. Among
patients with a DNA index greater than 1.16, patients with trisomies of
both chromosomes 4 and 10 had a 4-year EFS of 96.6% (n = 161, SE = 3.8%),
whereas patients with neither or only one of these trisomies had a 4-year
EFS of 70.4% (n = 73, SE = 11.5%). All 19 patients with a DNA index less
than or equal to 1.16 but with trisomies of chromosomes 4 and 10 remain in
remission, suggesting that favorable chromosome trisomy dominates in a
situation in which the cellular DNA content of less than or equal to 1.16
predicts a less favorable outcome. We conclude that combined trisomy of
chromosomes 4 and 10 independently predicts EFS among children with
B-progenitor ALL. Patients within the B-progenitor group who have this
feature (about 20% of those with clonal abnormalities) are likely to be
cured with antimetabolite-based chemotherapy--an approach that should
produce few significant late effects.
Volume 79,
Issue 12,
pp. 3316-3324,
06/15/1992
Copyright © 1992 by The American Society of Hematology
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