Abstract
Background: Early T-cell precursor (ETP) acute lymphoblastic leukemia/lymphoma (ALL) is a recently recognized high-risk T-ALL subgroup. The optimal therapeutic approaches to adult patients with ETP-ALL are poorly characterized. In this study, we compared the outcomes of adults with ETP-ALL who received treatment on frontline regimens to those of patients with other T-ALL immunophenotypic subtypes. Methods: Patients with newly-diagnosed T-ALL who received frontline chemotherapy between the years 2000 and 2014 at The University of Texas MD Anderson Cancer Center (MDACC) were identified and immunophenotypically categorized into early, thymic, and mature per the EGIL/WHO classification. Patients with ETP-ALL were identified on the basis of the following immunophenotype: CD1a(-), CD8(-), CD5(-/dim), and positivity for one or more stem cell or myeloid antigens. Results: A total of 111 patients with T-ALL with adequate immunophenotype data were identified. There was no difference in the outcomes of patients based on the EGIL/WHO subtypes. A total of 19patients (17%)hadETP-ALL.The completeremission rate(CR)/ CR with incomplete platelet recovery (CRp) rate in patients with ETP-ALL wassignificantly lowerthanthatofnon-ETP-ALL patients (73% vs. 91%; p¼0.03). The median overall survival for ETP-ALL patientswas20monthsvs.notreachedforthenon-ETP-ALLpatients (p ¼ 0.008). Conclusions: ETP-ALL represents a high-risk disease subtype of adult ALL. Allogeneic stem cell transplant in CR1 should be considered. Novel treatment strategies are needed to improve treatment outcomes in this T-ALL subset. Keywords: Acute leukemia, Lymphoblastic Leukemia, T-cell, Immunophenotype, Hyper-CVAD Chemotherapy, Flow Cytometry.
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