Faculty Opinions recommendation of Karyotype is an independent prognostic factor in adult acute lymphoblastic leukemia (ALL): analysis of cytogenetic data from patients treated on the Medical Research Council (MRC) UKALLXII/Eastern Cooperative Oncology Group (ECOG) 2993 trial.

Author(s):  
Thomas Habermann
Blood ◽  
2006 ◽  
Vol 109 (8) ◽  
pp. 3189-3197 ◽  
Author(s):  
Anthony V. Moorman ◽  
Christine J. Harrison ◽  
Georgina A. N. Buck ◽  
Sue M. Richards ◽  
Lorna M. Secker-Walker ◽  
...  

Abstract Pretreatment cytogenetics is a known predictor of outcome in hematologic malignancies. However, its usefulness in adult acute lymphoblastic leukemia (ALL) is generally limited to the presence of the Philadelphia (Ph) chromosome because of the low incidence of other recurrent abnormalities. We present centrally reviewed cytogenetic data from 1522 adult patients enrolled on the Medical Research Council (MRC) UKALLXII/Eastern Cooperative Oncology Group (ECOG) 2993 trial. The incidence and clinical associations for more than 20 specific chromosomal abnormalities are presented. Patients with a Ph chromosome, t(4;11)(q21;q23), t(8;14)(q24.1;q32), complex karyotype (5 or more chromosomal abnormalities), or low hypodiploidy/near triploidy (Ho-Tr) all had inferior rates of event-free and overall survival when compared with other patients. In contrast, patients with high hyperdiploidy or a del(9p) had a significantly improved outcome. Multivariate analysis demonstrated that the prognostic relevance of t(8;14), complex karyotype, and Ho-Tr was independent of sex, age, white cell count, and T-cell status among Ph-negative patients. The observation that Ho-Tr and, for the first time, karyotype complexity confer an increased risk of treatment failure demonstrates that cytogenetic subgroups other than the Ph chromosome can and should be used to risk stratify adults with ALL in future trials.


Author(s):  
Stephanie Roberta Monteiro Longaray ◽  
Dionéia Oliveira ◽  
Soraia Genebra Ibrahim Forgiarini ◽  
Vanessa Giendruczak da Silva

Introdução: Os cânceres hematológicos afetam o organismo com diversas disfunções, e a fisioterapia tem o intuito de auxiliar na prevenção e no tratamento, proporcionando uma melhor qualidade de vida. Objetivo: Verificar os efeitos de um protocolo fisioterapêutico em indivíduos com câncer hematológico. Método: Trata-se de um estudo quase-experimental, com participantes de 18 a 50 anos de idade, de ambos os sexos, realizado no Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre. Aplicou-se um protocolo fisioterapêutico por quatro semanas, conforme o estágio hematológico individual, no qual foram avaliados força, bem-estar geral e performance, além de fadiga, respectivamente, com as escalas: Medical Research Council (MRC), Karnofsky, Eastern Cooperative Oncology Group Performance Status (ECOG) e Multidimensional Fatigue Inventory (MFI) 20 - versão brasileira. Resultados: Foram incluídos 11 indivíduos. Verificou-se um aumento significativo da força muscular (p=0,024). Na avaliação do bem-estar geral e performance, não houve diferença significativa (p=0,192) e (p=0,368), assim como nos exames sanguíneos (p>0,05). Na análise dos sinais vitais, apenas a frequência respiratória apresentou aumento significativo no pré e pós-protocolo (p=0,04). Houve correlações significativas entre as escalas de Karnofsky e ECOG (r=-0,81;), MFI e ECOG (r=0,64) e MFI e de Borg (r=0,67), com p<0,05. Conclusão: Os resultados mostraram que é possível utilizar um protocolo fisioterapêutico que se adapte ao perfil hematológico e às condições clínicas do paciente nessa área, existindo correlações entre diversas variáveis funcionais avaliadas, contudo mais estudos são necessários.


Blood ◽  
2000 ◽  
Vol 96 (7) ◽  
pp. 2412-2418
Author(s):  
Kate A. Wheeler ◽  
Susan M. Richards ◽  
Clifford C. Bailey ◽  
Brenda Gibson ◽  
Ian M. Hann ◽  
...  

The role of bone marrow transplantation (BMT) in first remission of children with high-risk acute lymphoblastic leukemia (ALL) remains unclear. There were 3676 patients (aged 1 to 15 years) entered into the United Kingdom (UK) Medical Research Council (MRC) trials UKALL X and XI from 1985 to 1997. Of these patients, 473 patients (13%) were classified as very high (VH) risk and were eligible for a transplantation from a matched histocompatible sibling donor (MSD). We tissue-typed 286 patients; 99 patients had a matched related donor, and 76 patients received transplantations. Additionally, 25 children received transplantations from a matched unrelated donor (MUD) despite trial guidelines for MSD transplantations only. The median time to transplantation was 5 months (range, 2 to 19 months), and the median follow-up was 8 years. The 10-year event-free survival (EFS) adjusted for the time to transplantation, diagnostic white blood cell (WBC) count, Ph chromosome status, and ploidy was 6.0% higher (95% confidence interval (CI), −10.5% to 22.5%) for 101 patients who received a first-remission transplantation (MSD and MUD) than for the 351 patients treated with chemotherapy (transplantation, 45.3%, vs chemotherapy, 39.3%). The transplantation group had fewer relapses (31%) compared to relapses in the chemotherapy group (55%); however, the transplantation group had more remission deaths (18%) compared to remission deaths in the chemotherapy group (3%). In contrast the adjusted 10-year EFS was 10.7% higher (95% CI, −2.6% to 24.0%) for patients without a human leukocyte antigen (HLA)–matched donor than for those patients with a donor (no donor, 50.4%, vs donor, 39.7%). In conclusion, for the majority of children with VH-risk ALL, the first-remission transplantation has not improved EFS.


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