Background: The discrepancy of therapeutic outcome between pediatric and adult patients with acute lymphoblastic leukemia (ALL) can be attributed in part to the higher frequency of adverse genetic abnormalities in adults. Several features
such as
age, leukocyte count, karyotype, and the rapidity of leukemic cell clearance have been noted to influence outcome of adult ALL in chemotherapy setting. However, the prognostic relevance of these factors has not been definitely evaluated in
allogeneic
BMT setting.
Methods: A total of 41 consecutive adults with precursor B-lineage ALL who had a successful karyotype and treated with allogeneic BMT while in first or second complete remission (CR) were entered onto the study. Cases known to be t(9;22)
or
t(4;11) were classified as unfavorable karyotype.
Results: There were 21 males and 20 females with median age 27 (range, 15~43) years. The distribution of FAB types was as follows : L1 26 cases (63.4%), L2 15 cases (36.6%). Unfavorable karyotypes were identified in 12 patients (29.3%).
Disease
status at the time of transplant was first CR (n=37) or second CR (n=4). With a median follow-up of 26 months (range, 7~65 months), the probability of disease-free survival (DFS) was 66.5% and 49.9% at 2 and 5 years, respectively. In univariate
analyses, characteristics predicting for worse DFS were FAB type (L2), pretransplant status (second CR) and unfavorable karyotype. Further multivariate analysis showed that the most powerful predictive factor for DFS was karyotype (P<0.01).
Conclusion: Our clinical data shows that karyotype is the most important prognostic factor in adult precursor B-ALL after allogeneic BMT.

Keywords: Adult acute lymphoblastic leukemia, Allogeneic bone marrow transplantation, Karyotype, Prognostic factor,