Ph-like acute lymphoblastic leukemia: a high-risk subtype in adults
2017
Philadelphia chromosome(
Ph)-like acute lymphoblastic leukemia (
ALL) is a high-risk subtype of
ALLin children. There are conflicting data on the incidence and prognosis of
Ph-like
ALLin adults. Patients with newly diagnosed B-cell
ALL(B-
ALL) who received frontline chemotherapy at MD Anderson Cancer Center underwent gene expression profiling of leukemic cells. Of 148 patients, 33.1% had
Ph-like, 31.1% had
Ph+ , and 35.8% had other B-
ALLsubtypes (B-other). Within the
Ph-like
ALLcohort, 61% had
cytokine receptor-like factor 2 (CRLF2) overexpression. Patients with
Ph-like
ALLhad significantly worse overall survival (OS), and event-free survival compared with B-other with a 5-year survival of 23% (vs 59% for B-other, P = .006). Sixty-eight percent of patients with
Ph-like
ALLwere of Hispanic ethnicity. The following were associated with inferior OS on multivariable analysis: age (hazard ratio [HR], 3.299; P P = .017), platelet count (HR, 7.437; P = .005), and
Ph-like
ALL(HR, 1.818; P = .03). Next-generation sequencing of the CRLF2 +
group identifiedmutations in the JAK-STAT and Ras pathway in 85% of patients, and 20% had a CRLF2 mutation. Within the CRLF2 + group, JAK2 mutation was associated with inferior outcomes. Our findings show high frequency of
Ph-like
ALLin adults, an increased frequency of
Ph-like
ALLin adults of Hispanic ethnicity, significantly inferior outcomes of adult patients with
Ph-like
ALL, and significantly worse outcomes in the CRLF2 + subset of
Ph-like
ALL. Novel strategies are needed to improve the outcome of these patients.
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