Prognostic Value of the Immunological Subtypes of Adolescent and Adult T-Cell Lymphoblastic Lymphoma; an Ultra-High-Risk Pro-T/CD2(−) Subtype

(1) Background: T-cell lymphoblastic lymphoma (T-LBL) is extremely rare and highly aggressive, with no practical risk model defined yet. The prognostic value of T-LBL immunological subtypes is still a matter of controversy. (2) Methods: We re-evaluated 49 subsequent adult T-LBL patients treated according to the German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia (GMALL) protocols, 05/93 (n = 20) and T-LBL 1/2004 (n = 29), 85.7% of which achieved complete remission (CR). (3) Results: The 5/10-year overall survival (OS) and event-free survival (EFS) were 62%/59% and 48%/43%, respectively. In 96% of patients, flow cytometry analyses defining the WHO 2008 immunophenotypes were available. Cortical, early/pro-T/CD2(−), early/pre-T/CD2(+), and mature subtypes were identified in 59.5%, 19%, 15%, and 6.5% of patients, respectively. Overall, 20% of patients had the early T-cell precursor (ETP)-LBL immunophenotype, as proposed by the WHO 2017 classification. For the early/pro-T/CD2(−) subtype, the five-year OS and EFS were 13% and 13%, while for all the other, non-pro-T subtypes, they were 69% and 67%. By multivariate analysis, only CD2(−) status and age > 35 years emerged as strong, independent factors influencing OS and EFS, while the risk of CR failure was influenced by age only (>35 years). (4) Conclusions: ETP was non-significant for OS, unless an ultra-high-risk pro-T/CD2(−) subtype was concerned.

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Pediatric ALL-like Therapy in Adults with T-Cell Lymphoblastic Lymphoma: Results of the Graall-Lysa LL03 Study

Blood ◽

10.1182/blood.v124.21.371.371 ◽

2014 ◽

Vol 124 (21) ◽

pp. 371-371

Author(s):

Stephane Lepretre ◽

Aurore Touzart ◽

Thomas Vermeulin ◽

Jean-Michel Picquenot ◽

Aline Tanguy-Schmidt ◽

...

Keyword(s):

T Cell ◽

High Risk ◽

Prognostic Value ◽

Lymphoblastic Leukemia ◽

Multivariable Analysis ◽

Lymphoblastic Lymphoma ◽

Adult Patients ◽

High Dose ◽

Genetic Profile ◽

Cns Involvement

Abstract Background: It has been suggested that using an acute lymphoblastic leukemia (ALL) rather than non-Hodgkin lymphoma protocol to treat patients with lymphoblastic lymphoma (LL) might be associated with better results (Hoelzer, Best Pract Res Clin Haematol 2002). To address this issue, the GRAALL and LYSA groups have conducted the Phase 2 LL03 trial in adult patients with LL, using the GRAALL-2003 protocol, which yielded good results in adult patients with ALL (Huguet, JCO 2009). Patients and Methods: Between 2004 and 2012, 155 patients aged 18-59 years were enrolled, including 131 evaluable patients with T-cell LL (T-LL). The pediatric-inspired ALL treatment included a corticosteroid prephase, a 5-drug induction with sequential cyclophosphamide, high dose consolidation, late intensification, CNS prophylaxis with IT injections and cranial irradiation, and a 2-year maintenance. Response, including complete remission (CR) and unconfirmed CR (CRu), were assessed using Cheson criteria (Cheson, JCO 1999). Allogeneic stem cell transplantation (SCT) was offered to CR/CRu patients with high-risk disease (defined as need for a second-induction salvage course and/or CNS disease) and a donor. Results: Of 131 T-LL patients (median age, 33 years; M/F ratio 4.0; mediastinal enlargement, 95%; CNS involvement, 5%), 119 patients (91%) reached CR/CRu (30 patients needing a salvage course) and 34 relapsed. Response evaluation was based on CT scan, as PET scan was performed in only 73/131 and 20/30 patients after first induction and salvage, respectively. At 5 years, estimated DFS, EFS and overall survival were 71%, 61% and 66%, respectively. The lymphoma IPI-score had no prognostic value, but increased serum LDH level (observed in 71% of the patients) was associated with a significant decrease in EFS (HR = 2.8 [1.3 – 6.1]) and OS (HR = 3.5 [1.4 – 9.1]) in multivariable analysis. Of note, need for a salvage course was not associated with shorter DFS in CR/CRu patients. In a subset of 49 patients studied for oncogenetic markers, the 4-gene risk classifier (based on NOTCH1, FBXW7, N/K-RAS and PTEN status) we have recently reported to be a powerful predictor in T-ALL patients (Trinquand, JCO 2013) also demonstrated strong prognostic value in T-LL. Among these patients, 29 (60%) had a high-risk genetic profile (defined as no NOTCH1/FBXW7 mutation and/or N/K-RAS mutation and/or PTEN deletion). At 3 years, the high-risk genetic profile was predictive of shorter EFS (HR = 14.3 [1.9 – 107.8]), DFS (HR = 9.5 [1.2 – 74.3]) and OS (HR = 11.5 [1.5 – 87.5]) in univariable analysis, as well as in multivariable analysis after adjustment on age, ECOG-PS and LDH level (HR = 20.5 [2.6 – 164.1], 12.6 [1.5 – 104.8] and 17.0 [2.1 – 136.8], respectively. A total of 30 CR/CRu patients were eligible for allogeneic SCT (25 for late CR/CRu, 4 for CNS involvement, and 1 for both criteria) and 17 of them were actually transplanted in first CR/CRu. When analysed as a time-dependent event, allogeneic SCT was not associated with prolonged DFS in these high-risk patients. Finally, Grade III/IV adverse events were those commonly observed with the GRAALL regimen. Overall, 46 patients died during the study (37 after relapse or progression; 5 during induction; 3 from allograft toxicity and 1 after a highway accident). Conclusion: As compared to historical studies, we report here a relatively good outcome in T-LL patients treated with a pediatric-inspired ALL strategy. Very interestingly, the NOTCH1/FBXW7/RAS/PTEN T-ALL risk classification was also a strong prognostic factor in these T-LL patients. Allogeneic SCT did not appear to significantly influence the outcome of selected T-LL patients. Disclosures No relevant conflicts of interest to declare.

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Childhood T-Cell Acute Lymphoblastic Leukemia: The Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium Experience

Journal of Clinical Oncology ◽

10.1200/jco.2003.10.116 ◽

2003 ◽

Vol 21 (19) ◽

pp. 3616-3622 ◽

Cited By ~ 215

Author(s):

John M. Goldberg ◽

Lewis B. Silverman ◽

Donna E. Levy ◽

Virginia Kimball Dalton ◽

Richard D. Gelber ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

T Cell ◽

High Risk ◽

Lymphoblastic Leukemia ◽

Lymphoblastic Lymphoma ◽

Dana Farber Cancer Institute ◽

Cns Relapse ◽

Cell Acute Lymphoblastic Leukemia ◽

Induction Failure ◽

Worse Prognosis

Purpose: T-cell acute lymphoblastic leukemia (T-ALL) accounts for 10% to 15% of newly diagnosed cases of childhood acute lymphoblastic leukemia (ALL). Historically, T-ALL patients have had a worse prognosis than other ALL patients. Patients and Methods: We reviewed the outcomes of 125 patients with T-ALL treated on Dana-Farber Cancer Institute (DFCI) ALL Consortium trials between 1981 and 1995. Therapy included four- or five-agent remission induction; consolidation therapy with doxorubicin, vincristine, corticosteroid, mercaptopurine, and weekly high-dose asparaginase; and cranial radiation. T-ALL patients were treated the same as high-risk B-progenitor ALL patients. Fifteen patients with T-cell lymphoblastic lymphoma were also treated with the same high-risk regimen between 1981 and 2000. Results: The 5-year event-free survival (EFS) rate for T-ALL patients was 75% ± 4%. Fourteen of 15 patients with T-cell lymphoblastic lymphoma were long-term survivors. There was no significant difference in EFS comparing patients with T-ALL and B-progenitor ALL (P = .56), although T-ALL patients had significantly higher rates of induction failure (P < .0001), and central nervous system (CNS) relapse (P = .02). The median time to relapse in T-ALL patients was 1.2 years versus 2.5 years in B-progenitor ALL patients (P = .001). There were no pretreatment characteristics associated with worse prognosis in patients with T-ALL. Conclusion: T-ALL patients fared as well as B-progenitor patients on DFCI ALL Consortium protocols. Patients with T-ALL remain at increased risk for induction failure, early relapse, and isolated CNS relapse. Future studies should focus on the identification of and treatment for T-ALL patients at high risk for treatment failure.

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Outcome of risk-adapted therapy for pediatric acute lymphoblastic leukemia in Egypt.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.10044 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 10044-10044

Author(s):

Iman A. Sidhom ◽

Abir Mokhles ◽

Sonya Soliman ◽

Khaled Shaaban ◽

Sherine Salem ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

T Cell ◽

High Risk ◽

Lymphoblastic Leukemia ◽

Univariate Analysis ◽

Risk Groups ◽

Response To Therapy ◽

Cell Phenotype ◽

Free Survival ◽

Egyptian Children

10044 Background: With modern risk directed therapy, >80% of children with acute lymphoblastic leukemia (ALL) in western countries are cured. The 5-year event free survival (EFS) and relapse free survival (RFS) of pediatric ALL patients in Egypt were 65% and 75% respectively in a previous study using an intensive treatment protocol for all patients. Aim: To improve cure rates of Egyptian children with ALL using risk adapted therapy. Methods: From July 2007 to December 2010, 706 patients aged 1-18 years with newly diagnosed ALL were treated at Children Cancer Hospital Egypt with a risk directed ALL protocol adopted from St Jude Total Study XV. Results: B-precursor phenotype was encountered in 75.8% and T-cell in 24.2%. Based on initial presentation and response to therapy measured by minimal residual disease (MRD), 42.6%, 45.8% and 11.6% of the patients were classified as low, intermediate and high risk respectively. The 5-year RFS and EFS were 88.2 ± 1.5% and 76.5 ± 1.7% respectively. Adverse events included 4.4% induction deaths, 2.5% failure to achieve induction remission (1.4% remained refractory), 6.8% deaths in remission, 9.2% relapses (3.1% hematological, 1.8% combined hematological and CNS, 4% isolated CNS, 0.3% isolated testicular), 0.9% abandonment of therapy and one patient had secondary myeloid leukemia. The median follow up for patients alive in CR was 43months (range 24–65). The 5-year RFS of the low, intermediate and high risk groups were 92.2 ± 2.4%, 85.3 ± 2.2% and 82.7 ± 4.8% respectively (p=0.001), while the 5-year EFS were 87.6 ± 2.5%, 78.2 ± 2.5% and 57.9 ± 5.7% respectively (p<0.001). Prognostic factors that had statistically significant unfavorable impact on both EFS and RFS by univariate analysis were age ≥10 years, TLC ≥100x109/L, T-cell phenotype, risk groups, MRD d42 ≥1% and MRD W7 ≥0.1%, while MRD d15 ≥1% had statistically significant unfavorable outcome on EFS only. By multivariate analysis, TLC and MRD W7 had prognostic significance on EFS and RFS, MRD d42 on EFS, while MRD d15 had marginal significance on EFS (p=0.055). Conclusions: Risk adapted therapy was effective in improving ALL survival among patients at our institution compared with previous trials, although the outcome remains lower than that in high income countries.

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Superiority of Allogeneic Hematopoietic Stem-Cell Transplantation Compared With Chemotherapy Alone in High-Risk Childhood T-Cell Acute Lymphoblastic Leukemia: Results From ALL-BFM 90 and 95

Journal of Clinical Oncology ◽

10.1200/jco.2006.06.2679 ◽

2006 ◽

Vol 24 (36) ◽

pp. 5742-5749 ◽

Cited By ~ 79

Author(s):

André Schrauder ◽

Alfred Reiter ◽

Helmut Gadner ◽

Dietrich Niethammer ◽

Thomas Klingebiel ◽

...

Keyword(s):

Stem Cell ◽

Acute Lymphoblastic Leukemia ◽

T Cell ◽

High Risk ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Median Time ◽

Lymphoblastic Leukemia ◽

Hematopoietic Stem ◽

Free Survival

Purpose The role of hematopoietic stem-cell transplantation (SCT) in first complete remission (CR1) for children with very high–risk (VHR) acute lymphoblastic leukemia (ALL) is still under critical discussion. Patients and Methods In the ALL–Berlin-Frankfurt-Münster (BFM) 90 and ALL-BFM 95 trials, 387 patients were eligible for SCT if there was a matched sibling donor (MSD). T-cell ALL (T-ALL) patients with poor in vivo response to initial treatment represented the largest homogeneous subgroup within VHR patients. Results Of 191 high-risk (HR) T-ALL patients, 179 patients (94%) achieved CR1. Twenty-three patients received an MSD-SCT. Furthermore, in trial ALL-BFM 95, eight matched unrelated donors (MUDs) and five mismatched family donors (MMFDs) were used. The median time to SCT was 5 months (range, 2.4 to 10.8 months) from diagnosis. The 5-year disease-free survival (DFS) was 67% ± 8% for 36 patients who received an SCT in CR1 and 42% ± 5% for the 120 patients treated with chemotherapy alone having an event-free survival time of at least the median time to transplantation (Mantel-Byar, P = .01). Overall survival (OS) rate for the SCT group was 67% ± 8% at 5 years, whereas patients treated with chemotherapy alone had an OS rate of 47% ± 5% at 5 years (Mantel-Byar, P = .01). Outcome of patients who received MSD-SCT versus MUD-/MMFD-SCT was comparable (DFS, 65% ± 10% v 69% ± 13%, respectively). However, relapses only occurred after MSD-SCT (eight of 23 patients), whereas treatment-related mortality only occurred after MUD-/MMFD-SCT (four of 13 patients). Conclusion SCT in CR1 is superior to treatment with chemotherapy alone for childhood HR-T-ALL.

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Pediatric T-Cell Lymphoblastic Leukemia and T-Cell Lymphoblastic Lymphoma: Differences in the Common Deleted Region and the Prognostic Impact of Chromosome 6q Deletions.

Blood ◽

10.1182/blood.v108.11.294.294 ◽

2006 ◽

Vol 108 (11) ◽

pp. 294-294

Author(s):

Birgit Burkhardt ◽

Anja Moericke ◽

Wolfram Klapper ◽

Franziska Mueller ◽

Martin Schrappe ◽

...

Keyword(s):

T Cell ◽

Treatment Strategy ◽

Lymphoblastic Leukemia ◽

Disease Free Survival ◽

Lymphoblastic Lymphoma ◽

Prognostic Impact ◽

Free Survival ◽

Poor Outcome ◽

The Common ◽

Length Analysis

Abstract Background/Objectives: Deletions of chromosome 6q have been reported in a variety of hematological malignancies. Regarding their prognostic impact, however, the data are inconclusive, as most of the published studies included different subtypes, different immunophenotypes and/or differently treated patients (pts). Therefore our analyses focused on 109 pediatric pts with T-cell lymphoblastic-lymphoma (T-LBL) compared with 127 pediatric pts with T-cell lymphoblastic leukemia (T-ALL). Both groups were treated uniformly according to the BFM-ALL-type treatment strategy. Design/Methods: Deletions of chromosome 6q were examined by loss-of-heterozygosity (LOH) analysis of 25 microsatellite-markers located on chromosome 6q14-q24. DNA samples were amplified by PCR, followed by fragment-length analysis on a genetic analyzer. Results: Between 03/95-06/04 a total of 217 pediatric T-LBL pts were registered at the NHL-BFM study center and treated uniformly with ALL-type treatment strategy. 109 T-LBL pts were evaluable for LOH analysis, including 21 out of 27 pts who suffered relapse. In the 109 pts a total of 1,688 markers were analyzed successfully. Patterns of LOH were detectable in 22 pts. Analysis of the putative deleted regions revealed LOH of all informative markers in 5 pts and interstitial deletions in 17 cases. A common deleted region of 13 cases was flanked by markers D6S1682 and D6S1716 at band 6q16. There were no statistically significant differences in LOH-positive versus LOH-negative T-LBL pts with respect to age, sex ratio, stage, BM or CNS involvement. However, detection of LOH at 6q14-24 was associated with poor outcome: Probability of disease-free-survival (DFS) was 91±3% for LOH-negative versus 38±11% for LOH-positive pts (p<0.0001). In comparison, a total of 186 T-ALL pts were consecutively registered in the trial ALL-BFM 2000 between 08/99-06/02. Of these, 127 pts were evaluable for LOH analysis, including 22 out of 27 pts with relapse. In the 127 pts a total of 3,109 markers were analyzed successfully. Patterns of LOH were detected in 16 pts with proximal interstitial deletions in 15 out of the 16 cases. The 4.3 Mb common deleted region was flanked by markers D6S1627 and D6S1644. There were no significant differences between LOH-positive versus LOH-negative pts neither in clinical characteristics nor in treatment response or outcome. Conclusions: The pattern of 6q-deletions as well as the prognostic impact differ between pediatric T-LBL and T-ALL. LOH at 6q is detectable in 20% of pediatric T-LBL compared with 13% of pediatric T-ALL. In T-ALL the common deleted region is localized in chromosomal band 6q14. LOH is not associated with clinical parameters or outcome. In T-LBL the most frequently deleted marker is localized in band 6q16 and detectable LOH is associated with poor outcome. A prospective analysis of a larger series of pts is necessary to confirm the prognostic value of 6q deletions in T-LBL.

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Prognostic value of event-free survival at 24 months for adolescent and adult T-cell lymphoblastic lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20042 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20042-e20042

Author(s):

Haizhu Chen ◽

Yuankai Shi

Keyword(s):

T Cell ◽

Prognostic Value ◽

Prognostic Indicator ◽

Lymphoblastic Lymphoma ◽

Response To Treatment ◽

Event Free Survival ◽

Free Survival ◽

Aggressive Clinical Behavior ◽

Selection Of

e20042 Background: T-cell lymphoblastic lymphoma(L-LBL) has an aggressive clinical behavior. To date, powerful and consistent prognostic factors have not been established for adolescent and adult T-cell lymphoblastic lymphoma. In this study, we firstly evaluated the prognostic value of event-free survival (EFS) at 24 months (EFS24) for adolescent and adult T-LBL. Methods: Between January 2006 and December 2017, 91 adolescent and adult patients (aged≥12 years) with newly diagnosed T-LBL and treated with chemotherapy were retrospectively analyzed. EFS was defined as the time from initial diagnosis to relapse or progression, retreatment, death from any cause, or to the last follow up. Subsequent OS was defined as time from achieving EFS24 or time from progression in patients who did not achieve EFS24 to death from any cause or last follow-up. Results: In total, 91 patients with previously untreated T-LBL who had a median age of 24 years were enrolled. At a median follow-up of 40.4months (range, 1.4 to 163.3 months), the 5-year OS and EFS was 47.9% and 45.5%, respectively. Of all patients, 45(49.5%) achieved EFS24 and 46(50.5%) did not. EFS24 was associated with a markedly superior outcome, compared with no achievement of EFS24(5-year OS, 90.5% vs 3%). In addition, the median subsequent OS for patients achieving EFS24 was not reached (5-year subsequent OS, 84.9%), whereas median subsequent OS for patients without achieving EFS24 was only 5.5months (5-year subsequent OS, 2.7%). Multivariate analysis demonstrated that only response to treatment (CR vs no CR) was significantly associated with EFS (HR =0.219,95% CI 0.118-0.404, P < 0.001), and EFS24 achievement was an independent prognostic indicator for OS (HR = 0.044, 95% CI 0.016-0.120, P < 0.001). Conclusions: We confirm that EFS24 is an independent prognostic factor for OS, which can aid clinicians in discussions of risk stratification and in selection of subsequent treatments. Further validation in the context of directed prospective clinical trials is warranted.

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Immunogenomic Gene Signature of Cell-Death Associated Genes with Prognostic Implications in Lung Cancer

Cancers ◽

10.3390/cancers13010155 ◽

2021 ◽

Vol 13 (1) ◽

pp. 155

Author(s):

Pankaj Ahluwalia ◽

Meenakshi Ahluwalia ◽

Ashis K. Mondal ◽

Nikhil Sahajpal ◽

Vamsi Kota ◽

...

Keyword(s):

Lung Cancer ◽

T Cells ◽

Cell Death ◽

T Cell ◽

High Risk ◽

Lung Adenocarcinoma ◽

Risk Group ◽

High Risk Group ◽

Free Survival ◽

Cell Death Pathways

Lung cancer is one of the leading causes of death worldwide. Cell death pathways such as autophagy, apoptosis, and necrosis can provide useful clinical and immunological insights that can assist in the design of personalized therapeutics. In this study, variations in the expression of genes involved in cell death pathways and resulting infiltration of immune cells were explored in lung adenocarcinoma (The Cancer Genome Atlas: TCGA, lung adenocarcinoma (LUAD), 510 patients). Firstly, genes involved in autophagy (n = 34 genes), apoptosis (n = 66 genes), and necrosis (n = 32 genes) were analyzed to assess the prognostic significance in lung cancer. The significant genes were used to develop the cell death index (CDI) of 21 genes which clustered patients based on high risk (high CDI) and low risk (low CDI). The survival analysis using the Kaplan–Meier curve differentiated patients based on overall survival (40.4 months vs. 76.2 months), progression-free survival (26.2 months vs. 48.6 months), and disease-free survival (62.2 months vs. 158.2 months) (Log-rank test, p < 0.01). Cox proportional hazard model significantly associated patients in high CDI group with a higher risk of mortality (Hazard Ratio: H.R 1.75, 95% CI: 1.28–2.45, p < 0.001). Differential gene expression analysis using principal component analysis (PCA) identified genes with the highest fold change forming distinct clusters. To analyze the immune parameters in two risk groups, cytokines expression (n = 265 genes) analysis revealed the highest association of IL-15RA and IL 15 (> 1.5-fold, p < 0.01) with the high-risk group. The microenvironment cell-population (MCP)-counter algorithm identified the higher infiltration of CD8+ T cells, macrophages, and lower infiltration of neutrophils with the high-risk group. Interestingly, this group also showed a higher expression of immune checkpoint molecules CD-274 (PD-L1), CTLA-4, and T cell exhaustion genes (HAVCR2, TIGIT, LAG3, PDCD1, CXCL13, and LYN) (p < 0.01). Furthermore, functional enrichment analysis identified significant perturbations in immune pathways in the higher risk group. This study highlights the presence of an immunocompromised microenvironment indicated by the higher infiltration of cytotoxic T cells along with the presence of checkpoint molecules and T cell exhaustion genes. These patients at higher risk might be more suitable to benefit from PD-L1 blockade or other checkpoint blockade immunotherapies.

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Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report

Blood ◽

10.1182/blood.v78.11.2814.2814 ◽

1991 ◽

Vol 78 (11) ◽

pp. 2814-2822 ◽

Cited By ~ 121

Author(s):

CA Linker ◽

LJ Levitt ◽

M O'Donnell ◽

SJ Forman ◽

CA Ries

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Disease Free Survival ◽

Remission Induction ◽

Cell Phenotype ◽

Free Survival ◽

Prognostic Features ◽

Adult Acute Lymphoblastic Leukemia ◽

Disease Free

Abstract We treated 109 patients with adult acute lymphoblastic leukemia (ALL) diagnosed by histochemical and immunologic techniques. Patients were excluded only for age greater than 50 years and Burkitt's leukemia. Treatment included a four-drug remission induction phase followed by alternating cycles of noncrossresistant chemotherapy and prolonged oral maintenance therapy. Eighty-eight percent of patients entered complete remission. With a median follow-up of 77 months (range, 48 to 111 months), 42% +/- 6% (SEM) of patients achieving remission are projected to remain disease-free at 5 years, and disease-free survival for all patients entered on study is 35% +/- 5%. Failure to achieve remission within the first 4 weeks of therapy and the presence of the Philadelphia chromosome are associated with a 100% risk of relapse. Remission patients with neither of these adverse features have a 48% +/- 6% probability of remaining in continuous remission for 5 years. Patients with T-cell phenotype have a favorable prognosis with 59% +/- 13% of patients achieving remission remaining disease-free compared with 31% +/- 7% of CALLA-positive patients. Intensive chemotherapy may produce prolonged disease-free survival in a sizable fraction of adults with ALL. Improved therapy is needed, especially for patients with adverse prognostic features.

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