T-cell acute lymphoblastic leukemia (T-ALL) is a rare disease accounting for approximately 20-25% of adult cases of ALL. The outcome of adult T-ALL has improved in the past decades, but relapse remains the major cause of treatment failure. Few studies have reported on the long-term outcome of adults with T-ALL. We retrospectively reviewed the charts of 39 adult patients (pts) diagnosed with T-ALL and treated at our center between August 1986 and April 2004. Characteristics: Male/female ratio was 3.3/1. Median age was 28.4 years (16.8-73.2). ECOG PS: 0/1(n=27), ≥ 2 (n=12). Median WBC at diagnosis was 12.2 (0.9-445), Platelets 60.7 (6-270), LDH 150, 3/8 MRD availability,1/8 in CR1 after salvage chemotherapy) of whom two pts died due to aGVHD and infection after transplantation. 8 pts had refractory disease; Only 1/8 achieved CR on salvage chemotherapy. 16/30 (53%) relapsed of whom 12/16 (75%) died of disease progression, 1 died of sepsis in CR2 and 3 pts alive in CR2. Median follow up of the 15 surviving patients is 59 months (1.5-183.4). Results: Overall survival (OS) and event-free survival (EFS) at 3 years for all patients were 33.7% (95% CI 19-49%) and 28% (95% CI 13-43%) respectively. Using univariate analysis, significant factors for poor survival were CSF involvement: [3-year EFS was 14% vs 34% (p = 0.05)], LDH levels higher than 2 times normal [3-year EFS was 7% vs 43.5% (p = 0.005)] and ECOG PS ≥ 2: [3-year EFS was 16.6% vs 37% (p = 0.05)]. Non-significant factors included sex, age 50. Conclusions: Adult T-ALL presents more commonly in young males with a third having a mediastinal mass. The outcome of treatment results in a 30% long term disease free survival. Patients refractory to induction as well as those who relapse have poor prognosis. As expected poor PS, high LDH and CSF involvement dictates worse outcome. Neither age, nor high WBC count contributed to worse prognosis.
Full conference title:
47th American Society for Haematology
- ASH 47th (2005)