Author:
Sabina Chiaretti ,Monica Messina ,Irene Della Starza ,Alfonso Piciocchi ,Luciana Cafforio ,Marzia Cavalli ,Akram Taherinasab ,Michela Ansuinelli ,Loredana Elia ,Guglielmo Albertini Petroni ,Roberta La Starza ,Martina Canichella ,Alessia Lauretti ,Maria Ctristina Puzzolo ,Valentina Pierini ,Alessandra Santoro ,Orietta Spinelli ,Valerio Apicella ,Saveria Capria ,Francesco Di Raimondo ,Paolo De Fabritiis ,Cristina Papayannidis ,Anna Candoni ,Roberto Cairoli ,Marco Cerrano ,Nicola Fracchiolla ,Daniele Mattei ,Chiara Cattaneo ,Antonella Vitale ,Enrico Crea ,Paola Fazi ,Cristina Mecucci ,Alessandro Rambaldi ,Anna Guarini ,Renato Bassan ,Robin Foà
Abstract
Early recognition of Ph-like acute lymphoblastic leukemia cases could impact on the management and outcome of this subset of B-lineage ALL. To assess the prognostic value of the Ph-like status in a pediatric-inspired, minimal residual disease (MRD)-driven trial, we screened 88 B-lineage ALL cases negative for the major fusion genes (BCR-ABL1, ETV6-RUNX1, TCF3-PBX1 and KTM2Ar) enrolled in the GIMEMA LAL1913 front-line protocol for adult BCR/ABL1-negative ALL. The screening - performed using the BCR/ABL1-like predictor - identified 28 Ph-like cases (31.8%), characterized by CRLF2 overexpression (35.7%), JAK/STAT pathway mutations (33.3%), IKZF1 (63.6%), BTG1 (50%) and EBF1 (27.3%) deletions, and rearrangements targeting tyrosine kinases or CRLF2 (40%). The correlation with outcome highlighted that: i) the complete remission (CR) rate was significantly lower in Ph-like compared to non-Ph-like cases (74.1% vs 91.5%, p=0.044); ii) at time point 2 (TP2), decisional for transplant allocation, 52.9% of Ph-like cases vs 20% of non-Ph-like were MRD-positive (p=0.025); iii) the Ph-like profile was the only parameter associated with a higher risk of being MRD-positive at TP2 (p=0.014); iv) at 24 months, Ph-like patients had a significantly inferior event-free and disease-free survival compared to non-Ph-like patients (33.5% vs 66.2%, p=0.005 and 45.5% vs 72.3%, p=0.062, respectively). This study documents that Ph-like patients have a lower CR rate, EFS and DFS, as well as a greater MRD persistence also in a pediatric-oriented and MRD-driven adult ALL protocol, thus reinforcing that the early recognition of Ph-like ALL patients at diagnosis is crucial to refine risk-stratification and to optimize therapeutic strategies.
Publisher
Ferrata Storti Foundation (Haematologica)