Leukemia cell phenotype and prognosis: An analysis of 519 adults with acute leukemia

R. Mertelsmann, M. A.S. Moore, B. Clarkson

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13 Scopus citations

Abstract

Of 391 adult patients with acute nonlymphoblastic leukemia (ANLL) and 129 adults with acute lymphoblastic leukemia (ALL) treated on protocol chemotherapy at Memorial Sloan-Kettering Cancer Center from 1969-1981, 139 ANLL and 57 ALL were studied for TdT activity, 27 ANLL and 15 ALL for intracellular lysozyme levels, 95 ANLL and ~ 50 ALL for cytogenetic markers and 128 ANLL and ~ 30 ALL in the CFU-C assay. The diagnostic, prognostic, and pathophysiological significance of these phenotypic markers was analyzed in the context of clinical and morphological prognostic features of the total groups of patients with ANLL or ALL. Factors predicting a poor prognosis in ANLL were a) advanced age, b) undifferentiated morphology, c) low lysozyme levels, d) elevated TdT activity, e) normal growth pattern or no growth in culture, and f) the presence of abnormal metaphases. In ALL, a relatively poor prognosis was seen in patients with a) advanced age, b) male sex, c) intermediate TdT activities, d) elevated lysozyme levels, and e) in cases exhibiting the Philadelphia chromosome. The data obtained document that cell marker analysis provides the technology for objective and reproducible classification of hematopoietic neoplasias and identifies prognostically important subgroups not recognized by conventional cytological, cytochemical or histological means. Furthermore, these studies have provided evidence for bi-phenotypic and poly-phenotypic acute leukemias with features of both ANLL and ALL, probably requiring different forms of treatment in view of the poor prognosis of this entity on current treatment regimens. The implications of these observations for the management of patients with acute leukemias and for leukemia pathophysiology are discussed in view of recent studies in this laboratory demonstrating deranged Interleukin-2 production and response in patients with ALL and lymphoblastic transformation of chronic myeloid leukemia (CML-LB).

Original languageEnglish
Pages (from-to)561-583
Number of pages23
JournalBlood Cells
Volume8
Issue number3
StatePublished - 1982
Externally publishedYes

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