Acute Leukemia

2021 ◽  
Author(s):  
Richard A. Larson ◽  
Roland B Walter
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Who Classification ◽  
Lymphoblastic Leukemia ◽  
World Health ◽  
Acute Leukemias ◽  
Acute Myeloid

The acute leukemias are malignant clonal disorders characterized by aberrant differentiation and proliferation of transformed hematopoietic progenitor cells. These cells accumulate within the bone marrow and lead to suppression of the production of normal blood cells, with resulting symptoms from varying degrees of anemia, neutropenia, and thrombocytopenia or from infiltration into tissues. They are currently classified by their presumed cell of origin, although the field is moving rapidly to genetic subclassification. This review covers epidemiology; etiology; classification of leukemia by morphology, immunophenotyping, and cytogenetic/molecular abnormalities; cytogenetics of acute leukemia; general principles of therapy; acute myeloid leukemia; acute lymphoblastic leukemia; and future possibilities. The figure shows the incidence of acute leukemias in the United States. Tables list World Health Organization (WHO) classification of acute myeloid leukemia and related neoplasms, expression of cell surface and cytoplasmic markers for the diagnosis of acute myeloid leukemia and mixed-phenotype acute leukemia, WHO classification of acute lymphoblastic leukemia, WHO classification of acute leukemias of ambiguous lineage, WHO classification of myelodysplastic syndromes, European LeukemiaNet cytogenetic and molecular genetic subsets in acute myeloid leukemia with prognostic importance, cytogenetic and molecular subtypes of acute lymphoblastic leukemia, terminology used in leukemia treatment, and treatment outcome for adults with acute leukemia. This review contains 2 figures, 15 tables, and 119 references. Keywords: Acute leukemia, acute myeloid leukemia, acute lymphoblastic leukemia, cancer, cytogenetics, chromosomal abnormality

Acute Leukemia

2016 ◽  
Author(s):  
Richard A. Larson ◽  
Roland B Walter
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Who Classification ◽  
Lymphoblastic Leukemia ◽  
World Health ◽  
Acute Leukemias ◽  
Acute Myeloid

The acute leukemias are malignant clonal disorders characterized by aberrant differentiation and proliferation of transformed hematopoietic progenitor cells. These cells accumulate within the bone marrow and lead to suppression of the production of normal blood cells, with resulting symptoms from varying degrees of anemia, neutropenia, and thrombocytopenia or from infiltration into tissues. They are currently classified by their presumed cell of origin, although the field is moving rapidly to genetic subclassification. This review covers epidemiology; etiology; classification of leukemia by morphology, immunophenotyping, and cytogenetic/molecular abnormalities; cytogenetics of acute leukemia; general principles of therapy; acute myeloid leukemia; acute lymphoblastic leukemia; and future possibilities. The figure shows the incidence of acute leukemias in the United States. Tables list World Health Organization (WHO) classification of acute myeloid leukemia and related neoplasms, expression of cell surface and cytoplasmic markers for the diagnosis of acute myeloid leukemia and mixed-phenotype acute leukemia, WHO classification of acute lymphoblastic leukemia, WHO classification of acute leukemias of ambiguous lineage, WHO classification of myelodysplastic syndromes, European LeukemiaNet cytogenetic and molecular genetic subsets in acute myeloid leukemia with prognostic importance, cytogenetic and molecular subtypes of acute lymphoblastic leukemia, terminology used in leukemia treatment, and treatment outcome for adults with acute leukemia. This review contains 1 highly rendered figure, 9 tables, and 117 references.

Acute Leukemia

2018 ◽  
Author(s):  
Richard A. Larson ◽  
Roland B Walter
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Who Classification ◽  
Lymphoblastic Leukemia ◽  
World Health ◽  
Acute Leukemias ◽  
Acute Myeloid

The acute leukemias are malignant clonal disorders characterized by aberrant differentiation and proliferation of transformed hematopoietic progenitor cells. These cells accumulate within the bone marrow and lead to suppression of the production of normal blood cells, with resulting symptoms from varying degrees of anemia, neutropenia, and thrombocytopenia or from infiltration into tissues. They are currently classified by their presumed cell of origin, although the field is moving rapidly to genetic subclassification. This review covers epidemiology; etiology; classification of leukemia by morphology, immunophenotyping, and cytogenetic/molecular abnormalities; cytogenetics of acute leukemia; general principles of therapy; acute myeloid leukemia; acute lymphoblastic leukemia; and future possibilities. The figure shows the incidence of acute leukemias in the United States. Tables list World Health Organization (WHO) classification of acute myeloid leukemia and related neoplasms, expression of cell surface and cytoplasmic markers for the diagnosis of acute myeloid leukemia and mixed-phenotype acute leukemia, WHO classification of acute lymphoblastic leukemia, WHO classification of acute leukemias of ambiguous lineage, WHO classification of myelodysplastic syndromes, European LeukemiaNet cytogenetic and molecular genetic subsets in acute myeloid leukemia with prognostic importance, cytogenetic and molecular subtypes of acute lymphoblastic leukemia, terminology used in leukemia treatment, and treatment outcome for adults with acute leukemia. This review contains 1 highly rendered figure, 9 tables, and 117 references.

MicroRNA Expression Signatures Accurately Discriminate Acute Lymphoblastic Leukemia from Acute Myeloid Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 231-231
Author(s):  
Shuangli Mi ◽  
Jun Lu ◽  
Miao Sun ◽  
Zejuan Li ◽  
Hao Zhang ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Target Genes ◽  
Lymphoblastic Leukemia ◽  
Acute Leukemias ◽  
In Vivo Models ◽  
Acute Myeloid

Abstract Human acute leukemias include acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). It is estimated that 5,200 and 13,410 cases will be diagnosed with and 1,420 and 8,990 will die of ALL and AML, respectively, in the United States in 2007. Although remarkable progress has been made in the past decades in the treatment and in the understanding of the biology of acute leukemias, the 5-year overall survival rate of patients with AML is only approximately 22%, which is much lower than that of ALL patients (65%; http://seer.cancer.gov). One of the most exciting recent findings is the discovery of an abundant class of small (∼22 nt), non-(protein-)coding RNAs, called microRNAs (miRNAs, miRs), which can function as oncogenes and tumor suppressors, whose deregulation is clearly associated with the development of cancer. To understand the distinct mechanisms in leukemogenesis between ALL and AML and to identify novel markers for diagnosis and treatment of acute leukemia, we have performed a large-scale miRNA expression profiling assay with a bead-based flow cytometric method and identified 27 differentially expressed miRNAs. Among them, miR-128a and b are significantly overexpressed while let-7b and miR-223 are significantly down-regulated in ALL compared to AML. They are the most discriminatory miRNAs between ALL and AML. Using the expression signatures of any two of the four most significantly discriminatory miRNAs in diagnosis of ALL and AML resulted in an accuracy rate of 97–100%. The differential expression patterns of these four miRNAs were validated further through quantitative real-time PCR on 98 acute leukemia samples covering most of the common cytogenetic subtypes of AML and B- and T-cell ALL, along with 10 normal controls. Furthermore, we found that overexpression of miR-128a and b in ALL was at least partly associated with hypomethylation, rather than amplification of DNA locus copy. Moreover, several important target genes of these four miRNAs have also been validated. We are currently exploring the role of these four miRNAs and their critical target genes in leukemogenesis and in the determination of lineage fate during leukemia development using in vitro and in vivo models. This work will enhance our understanding of the biological role of these miRNAs and their targets in leukemogenesis, and in determining the lineage fate of acute leukemia.

scholarly journals Poor Prognosis Biomolecular Factors Are Highly Frequent in Childhood Acute Leukemias From Oaxaca, Mexico

2020 ◽  
Vol 19 ◽  
pp. 153303382092843
Author(s):  
Gerardo Juárez-Avendaño ◽  
Nuria Citlalli Luna-Silva ◽  
Euler Chargoy-Vivaldo ◽  
Laura Alicia Juárez-Martínez ◽  
Mayra Noemí Martínez-Rangel ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
B Cell ◽  
Myeloid Leukemia ◽  
Poor Prognosis ◽  
Lymphoblastic Leukemia ◽  
Acute Leukemias ◽  
Cell Acute Lymphoblastic Leukemia ◽  
Acute Myeloid

Objective: To investigate the cellular and molecular epidemiology of acute leukemias in vulnerable populations of children and adolescents in Oaxaca de Juarez, Mexico. Material and Methods: Descriptive, cross-sectional and retrospective study, conducted from 2014 to 2018 in which profiles of molecular and immunophenotypic aberrations were investigated in children and adolescents diagnosed with acute leukemia, by evaluating 28 molecular abnormalities by HemaVision-Q28 multiplex RT-PCR kit and standardized EuroFlow Immunophenotyping of bone marrow cells. Results: We included 218 patients, with 82.5% younger than 14 years and 17.5% adolescents. The median age was 9 years and a main peak of incidence was recorded at age of 4 to 5 years. B-cell acute lymphoblastic leukemia was diagnosed in 70.64% of all cases, acute myeloid leukemia was in 22.48%, T-cell acute lymphoblastic leukemia in 6.42%, and mixed lineage acute leukemia in 0.46% of cases. Overall, chromosomal translocations were positive in 29.82% of cases. While 65.31% of patients with acute myeloid leukemia reported aberrancies, only in 18.83% of B-cell acute lymphoblastic leukemia cases genetic abnormalities were obvious. Surprisingly, most prevalent translocations in B-cell acute lymphoblastic leukemia were t(9;22) in 20.7%, followed by t(4;11) in 17.2% and t(6;11) in 13.8%, whereas patients with acute myeloid leukemia showed t(15;17) in 40.6% and t(8;21) in 21.9%. In contrast, an homogeneous expression of t(3;21) and t(6;11) was recorded for T-cell acute lymphoblastic leukemia and mixed lineage acute leukemia cases, respectively. Except for t(1;19), expressed only by pre-B cells, there was no association of any of the studied translocations with differentiation stages of the B-leukemic developmental pathway. Conclusion: Our findings identify near 50% of patients with acute lymphoblastic leukemia at debut with high-risk translocations and poor prognosis in B-cell acute lymphoblastic leukemia as well as an unexpected increase of acute myeloid leukemia cases in young children, suggesting a molecular shift that support a higher incidence of poor prognosis cases in Oaxaca.

scholarly journals Spinal Cord Compression in Patients with Acute Myeloid and Lymphoid Leukemia

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Shehab Fareed Mohamed ◽  
Elabbass Abdelmahmuod ◽  
Elrazi Awadelkarim A Ali ◽  
Abdulqadir Jeprel Nashwan ◽  
Dina Sameh Soliman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Spinal Cord Compression ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Cord Compression ◽  
Myeloid Sarcoma ◽  
Acute Myeloid

Introduction Acute leukemias can be divided into acute myeloid leukemia and acute lymphoblastic leukemia. Common presentations of acute leukemia include fever, symptoms of anemia, bleeding, bone pain palpable Lymph nodes or spleen and symptoms due inflation or leukocystasis. Extramedullary mass is rare and can be of myeloid tissue and known as Chloroma or myeloid (granulocytic) sarcoma which one of the WHO classifications for acute myeloid leukemia. Common sites of occurrence are skin, sinuses, bone and other. It's rarely involve central nervous system. Spinal cord involvement usually manifest as epidural mass causing cord compression. Spinal epidural tumor with acute leukemia and myeloid sarcoma is rare and can be found in 3-9% in patients with leukemia. In this review we decide to review the cases of spinal cord compression caused by acute myeloid leukemia (including Chloroma) and acute lymphoblastic leukemia due to the significance of such presentation in addition to reports that Myeloid sarcoma of the spine has very poor prognosis Methodology: We have reviewed the literature using: PubMed, google scholar, Scopus for patient with spinal cord compression and acute leukemia. We used the search term and synonyms : : acute myeloid leukemia , acute myelocytic leukemia , acute monocytic leukemia , acute lymphoblastic leukemia , acute lymphoid leukemia, chloroma , myeloid sarcoma ,granulocytic sarcoma, spinal cord compression .We included adult patients above 18 years old only cases we exclude pediatrics cases and cases of chronic leukemia's and other myeloproliferative disorders as well as cases of central nervous system involvement other than spinal cord Results We gathered the information from 98 cases with general demographics, presentation, image modality, cytogenetics and molecular in addition to management and outcome. We have found mean age for the patients is 38 years old with male predominance with 70% of the cases. The most presenting symptom was back pain in around 75% of the cases. Neurological findings showed sensory loss and parapreresis in most of the documented cases. MRI was most performed modality of imaging 63% followed by Computed tomography(CT) 15 % and then myelogram 13 %, which is least used due to invasive nature and before the era of MRI. The most common affected site on spinal cord were thoracic followed by lumbar. Cytogenetics and molecular data was not reported in most of the cases. Patients were treated with either steroids or surgery or radiotherapy and or chemotherapy while few underwent bone marrow transplant, but the most common approach was surgery+ radiotherapy + chemotherapy combination. Steroids used in most of the cases especially in the cases of acute lymphoblastic leukemia and dexamethasone was the steroids of the choice mainly. The outcome of the patients were variable, 30 % were alive at the time of the reports 30 % died and 30 % between relapse and complete remission. Conclusions Acute leukemia can be presented as mass causing spinal cord compression which is very serious. There are is no standardized management of patients with acute leukemia who presented with spinal cord compression nether guidelines or steps to follow. Some reports speculated also specific morphology and cytogenetics association with predisposition to have Extramedullary mass, however there lack of reporting of such a valuable information. Large studies including all adjusted variables required to determine if spinal cord compression presentation can be an independent risk facto or not Effective diagnosis and prompt action should take place. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Enrichment of Double RUNX1 Mutations in Acute Leukemias of Ambiguous Lineage

2021 ◽  
Vol 11 ◽  
Author(s):  
Gabriele Merati ◽  
Marianna Rossi ◽  
Anna Gallì ◽  
Elisa Roncoroni ◽  
Silvia Zibellini ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Genetic Basis ◽  
Lymphoblastic Leukemia ◽  
Gene Mutations ◽  
Rare Type ◽  
Acute Leukemias ◽  
Therapeutic Guidelines ◽  
Acute Myeloid

Acute leukemia of ambiguous lineage (ALAL) is a rare type of leukemia and represents an unmet clinical need. In fact, due to heterogeneity, substantial rarity and absence of clinical trials, there are no therapeutic guidelines available. We investigated the genetic basis of 10 cases of ALAL diagnosed at our centre from 2008 and 2020, through a targeted myeloid and lymphoid sequencing approach. We show that this rare group of acute leukemias is enriched in myeloid-gene mutations. In particular we found that RUNX1 mutations, which have been found double mutated in 40% of patients and tend to involve both alleles, are associated with an undifferentiated phenotype and with lineage ambiguity. Furthermore, because this feature is typical of acute myeloid leukemia with minimal differentiation, we believe that our data strengthen the idea that acute leukemia with ambiguous lineage, especially those with an undifferentiated phenotype, might be genetically more closer to acute myeloid leukemia rather than acute lymphoblastic leukemia. These data enrich the knowledge on the genetic basis of ALAL and could have clinical implications as an acute myeloid leukemia (AML) – oriented chemotherapeutic approach might be more appropriate.

scholarly journals CHARACTERISTICS CHANGES IN PRO-OXIDANT-ANTIOXIDANT STATUS IN PATIENTS WITH ACUTE LEUKEMIA DURING CHEMOTHERAPY

2020 ◽  
Vol 20 (1) ◽  
pp. 23-28
Author(s):  
H.S. Maslova ◽  
I.M. Skrypnyk ◽  
O.F. Hopko
Keyword(s):  
Lipid Peroxidation ◽  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Catalase Activity ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Thiobarbituric Acid ◽  
Thiobarbituric Acid Reactive Substances ◽  
Acute Myeloid

Changes in the processes of lipid peroxidation and antioxidant system activity are involved in the pathogenesis of carcinogenesis and can affect tumor resistance to chemotherapy. The aim of this study to investigate the nature of changes in pro-oxidant-antioxidant status in patients with acute leukemia during remission induction chemotherapy.  Materials and methods. The study involved 42 patients with newly diagnosed acute leukemia, 22 of them were diagnosed to have acute myeloid leukemia and 20 patients had acute lymphoblastic leukemia. The age range was 18-58 years, there were 19 women (45.2%) and 23 men (54.8%). The patients were divided into two groups: I (n=22) included patients with acute myeloid leukemia, who had chemotherapy modes "7+3" and "5+2" for variants M0-2 and "7+3+etoposide" or "5+2+etoposide" for M4-5 variants; II (n=20) group included patients with acute lymphoblastic leukemia, who received chemotherapy according to D. Hoelzer protocol. Hemogram parameters (red blood cells, hemoglobin, white blood cells, platelets) were evaluated at baseline and on the 28th day of chemotherapy. The concentration of thiobarbituric acid reactive substances and catalase activity in the blood serum were assessed as well. Examination of acute myeloid leukemia patients was performed before the chemotherapy, on the 4th and 28th days since chemotherapy started; acute lymphoblastic leukemia patients were examined before chemotherapy, on the 23rd and 28th days. The group of healthy individuals consisted of 20 persons, including 9 (45%) women and 11 (55%) men, aged 22-26 years. Results. The detailed clinical picture of acute leukemia was accompanied by typical changes in hemogram in the patients of both test groups, and namely, by the development of leukocytosis, anemia, thrombocytopenia. At the same time, the patients with acute myeloid leukemia and acute lymphoblastic leukemia demonstrated an increased concentration of thiobarbituric acid reactive substances in 1.8 and 1.89 times, respectively (p<0.05) that was accompanied by an increased serum catalase activity in 1.96 and 1.8 times, respectively (p<0.05) compared to healthy individuals. During "7+3" chemotherapy, acute myeloid leukemia patients were found to show thiobarbituric acid reactive substances increased in 1.9 times on the 4th day of treatment and decreased on the 28th day.The patients with acute lymphoblastic leukemia managed according to the D. Hoelzer protocol demonstrated an increased concentration of thiobarbituric acid reactive substances in the blood serum in 1.33 times on the 23rd day of treatment (p<0.05), maintaining this level up to the 28th day. The catalase activity in the patients of the comparison groups did not change. Conclusion. The debut of acute leukemia is accompanied by activation of lipid peroxidation and antioxidant system enzymes. Сhemotherapy promotes the shift of the prooxidant-antioxidant equilibrium towards the lipid peroxidation activation.

scholarly journals Sociodemographic Disparities in Chemotherapy and Hematopoietic Cell Transplantation Utilization Among Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2374-2374
Author(s):  
Matthew J. Wieduwilt ◽  
Brice Jabo ◽  
Maria Elena Martinez ◽  
Mark Ghamsary ◽  
John W. Morgan
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Myeloid Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Lymphoblastic Leukemia ◽  
Hematopoietic Cell ◽  
Transplant Center ◽  
Acute Myeloid

Abstract Introduction:Chemotherapy and hematopoietic cell transplantation (HCT) are cornerstones of therapy for acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Identifying sociodemographic factors affecting utilization of chemotherapy and HCT may help improve outcomes for more patients with acute leukemia. Methods: Using the California Cancer Registry, we performed a retrospective population-based study of treatment administration in patients ≥15 years of age diagnosed with ALL (n=3,221) or AML (n=10,029) between 1/2003 and 12/2012. The effect of age, sex, race/ethnicity, marital status, neighborhood socioeconomic status (nSES), and distance from nearest transplant center on the receipt of no treatment, chemotherapy alone, or chemotherapy followed by HCT was assessed. Chemotherapy and HCT were common events ensuring that odds ratios for treatment would overestimate relative risk (RR). Log-binomial and negative binomial regression models did not converge so Poisson regression with robust confidence intervals was used to estimate crude and adjusted RR with 95 percent confidence interval limits (CIs). Model fitness assumption using Pearson's chi-squared tests did not reveal over dispersion. Testing for multicollinearity showed no highly correlated covariates. Influence analysis did not identify influential observations or critical outliers. The Cochran-Armitage test for trend was used to assess changes in treatment utilization over time. Predictors were selected a priori based on published studies. Google maps API was used to compute the shortest driving distance between place of residence and nearest transplant centers. All statistical tests were 2-sided and conducted at a significance level of 0.05. Results: Patients <60 years of age comprised 75.5% of ALL and 31.5% of AML patients. Females represented 43% of ALL and 45% of AML patients. ALL represented 47.3% of acute leukemia cases in Hispanics versus 20.5%, 19.0% and 15.6% in Asian/other, non-Hispanic blacks, and non-Hispanic whites, respectively. Among ALL patients, 11%, 75% and 14% received no treatment, chemotherapy, or chemotherapy followed by HCT, respectively. For AML patients, 36% received no treatment while 53% and 11% were treated with chemotherapy or chemotherapy followed by HCT, respectively. HCT rates were highest in 40-59 year-old (yo) ALL patients (21.3%) and 15-39 yo AML patients (31.3%). Only 3.4% of ALL patients and 3.6% of AML patients over ≥60 yo underwent HCT. Covariate-adjusted findings showed a decreasing RR of chemotherapy with increasing age for ALL (trend p <0.001) and AML (trend p <0.001). Compared to 40-59 yos, those ≥60 years of age had reduced utilization of chemotherapy and HCT [ALL, RR 0.20 (95% CI=0.14-0.29); AML, RR 0.23 (95% CI=0.20-0.26)]. Overall, older acute leukemia patients showed increasing utilization of chemotherapy and HCT over the study period. For ALL patients ≥60 yo, chemotherapy utilization was stable (p=0.38) while HCT utilization increased from 5% in 2005 to 9% in 2012 (p=0.03). Among AML patients ≥60 yo, chemotherapy utilization increased from 39% in 2003 to 58% in 2012 (p<0.001) and HCT utilization from 5% in 2003 to 9% in 2012 (p<0.001). Relative to non-Hispanic whites, lower HCT utilization was observed in Hispanic white [ALL, RR=0.80 (95% CI =0.65-0.98); AML, RR=0.86 (95% CI =0.75-0.99)] and non-Hispanic black patients [ALL, RR=0.40 (95% CI =0.18-0.89); AML, RR=0.60 (95% CI =0.44-0.83)]. Compared to married patients, never married patients had a lower RR of receiving chemotherapy [ALL, RR=0.96 (95% CI=0.92-0.99); AML, RR=0.94 (95% CI=0.90-0.98)] or HCT [ALL, RR=0.58 (95% CI=0.47-0.71); AML, RR=0.80 (95% CI=0.70-0.90)]. Lower nSES quintiles predicted lower chemotherapy and HCT utilization for ALL and AML (Trend p <0.001).For ALL and AML, the lowest SES quintile had a lower RR of chemotherapy [ALL, RR= 0.95 (95% CI 0.90-0.99); AML, RR=0.89 (95% CI 0.84-0.94)] and HCT [ALL, RR=0.63 (95% CI 0.47-0.84); AML, RR=0.52 (95% CI 0.43-0.64)] compared to the highest nSES quintile. Distance from a transplant center had no impact on the receipt of chemotherapy or HCT. Conclusions : Older age, lower neighborhood SES, and being unmarried predicted lower utilization of both chemotherapy and HCT among ALL and AML patients. Addressing these disparities may increase utilization of known curative therapies and improve survival in underserved acute leukemia patients. Disclosures No relevant conflicts of interest to declare.

Improved Outcome With T-Cell–Depleted Bone Marrow Transplantation for Acute Leukemia

1999 ◽  
Vol 17 (5) ◽  
pp. 1545-1545 ◽  
Author(s):  
Franco Aversa ◽  
Adelmo Terenzi ◽  
Alessandra Carotti ◽  
Rita Felicini ◽  
Roberta Jacucci ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
T Cell ◽  
Acute Leukemia ◽  
Myeloid Leukemia ◽  
Antithymocyte Globulin ◽  
Lymphoblastic Leukemia ◽  
Acute Myeloid

PURPOSE: To eliminate the risk of rejection and lower the risk of relapse after T-cell–depleted bone marrow transplants in acute leukemia patients, we enhanced pretransplant immunosuppression and myeloablation. PATIENTS AND METHODS: Antithymocyte globulin and thiotepa were added to standard total-body irradiation/cyclophosphamide conditioning. Donor bone marrows were depleted ex vivo of T lymphocytes by soybean agglutination and E-rosetting. This approach was tested in 54 consecutive patients with acute leukemia who received transplants from HLA-identical sibling donors or, in two cases, from family donors mismatched at D-DR. No posttransplant immunosuppressive treatment was given as graft-versus-host disease (GVHD) prophylaxis. RESULTS: Neither graft rejection nor GVHD occurred. Transplant-related deaths occurred in six (16.6%) of 36 patients in remission and in seven (38.8%) of 18 patients in relapse at the time of transplantation. The probability of relapse was .12 (95% confidence interval [CI], 0 to .19) for patients with acute myeloid leukemia and .28 (95% CI, .05 to .51) for patients with acute lymphoblastic leukemia who received transplants at the first or second remission. At a median follow-up of 6.9 years (minimum follow-up, 4.9 years), event-free survival for patients who received transplants while in remission was .74 (95% CI, .54 to .93) for acute myeloid leukemia patients and .59 (95% CI, .35 to .82) for acute lymphoblastic leukemia patients. All surviving patients have 100% performance status. CONCLUSION: Adding antithymocyte globulin and thiotepa to the conditioning regimen prevents rejection of extensively T-cell–depleted bone marrow. Even in the complete absence of GVHD, the leukemia relapse rate is not higher than in unmanipulated transplants.

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