When it comes to haematological malignancy, other than APML (where treatment has been revolutionised by ATRA and arsenic), outcomes are greatly variable. Studies looking at AML have found a great deal of chromosomal and genetic variations are responsible for prognostic heterogeneity – and now this article in the NEJM looks at the same for ALL.
For haematology, this is a relatively massive study, looking at over 1,000 patients. High risk features included:
- older age
- high leucocyte count
- leukaemia with a T cell phenotype
- Philadelphia chromosome
- 11q23 rearrangement
They also found that allo stem cell transplant was better than chemotherapy for T-cell, and the opposite for B-cell if there were no other adverse features. High hyperdiploidy and age between 1-5 was also favourable in those with precursor B-cell leukaemia.
It’s these articles that not only allow us to risk stratify, but also to target the therapies we do have (SCT, chemotherapy) more appropriately – at least until more specific therapies arrive.
Read it here.
source | NEJM
image | VashiDonsk