Adults with Acute Lymphoblastic Leukemia and T(1;19) Abnormality Have a Favorable Outcome with Hyper-CVAD Chemotherapy

Among the well-described cytogenetic abnormalities in adults with acute lymphoblastic leukemia (ALL), a translocation involving chromosomes 1 and 19 [t(1;19) (q23;p13)] occurs in a small subset but has varyingly been associated with a good or bad prognosis in different studies. Adults with ALL and t(1;19) treated at M.D. Anderson Cancer Center were reviewed. Their clinical features and outcome were compared to those with other cytogenetic abnormalities. Endpoints included complete remission rate (CR), complete response duration (CRD) and overall survival (OS). Of 411 adults with pre-BALL, 12 patients had t(1;19). Ten of the 12 patients with t(1;19) received Hyper-CVAD (Cyclophosphamide, Vincristine, Adriamycin, Dexamethasone alternating with Methotrexate and high-dose Cytarabine); the other 2 were treated with VAD (Vincristine, Adriamycin, Dexamethasone). All 12 patients achieved CR; the 3-year survival rate was 73%. Patients with t(1;19) had significantly better CRD and OS when compared to all other patients combined as well as individually to patients with Ph+, t(4;11), and lymphoma-like abnormalities [6q(−), 14q+, t(11;14), t(14;18)]. Adults with ALL and t(1;19) have an excellent prognosis when treated with the Hyper-CVAD regimen. Outcome of patients by cytogenetic group: t(1;19) vs. individual cytogenetic groups | OVERALL SURVIVAL | N | Fail | 3-Year % | Median (weeks) | P-value | |:--------------------------------:| --- | ---- | -------- | -------------- | ------- | | T(1,19) | 12 | 3 | 73 | Not recorded | | | Diploid | 138 | 72 | 52 | 179 | 0.09 | | Lymphoma-like | 20 | 17 | 35 | 54 | 0.008 | | Ph+ | 117 | 88 | 23 | 68 | 0.0002 | | Miscellaneous | 112 | 56 | 56 | 236 | 0.17 | | T(4,11) | 12 | 10 | | 58 | 0.002 | | COMPLETE RESPONSE DURATION (CRD) | N | Fail | 3-Year % | Median (weeks) | P-value | | T(1,19) | 12 | 2 | 80 | Not recorded | | | Diploid | 133 | 59 | 54 | 177 | 0.06 | | Lymphoma-like | 16 | 13 | 34 | 89 | 0.009 | | Ph+ | 102 | 52 | 42 | 63 | 0.006 | | Miscellaneous | 100 | 41 | 59 | 401 | 0.16 | | T(4,11) | 11 | 7 | NR | 45 | 0.018 |