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High-Risk Lymphoblastic Leukemia Subtype Studied

Patients with early T-cell precursor leukemia have higher risk of remission failure

WEDNESDAY, Jan. 14 (HealthDay News) -- Acute lymphoblastic leukemia (ALL) patients who have the early T-cell precursor subtype of the disease are more likely to have a relapse than those with typical T-cell acute lymphoblastic leukemia (T-ALL), according to research published online Jan. 14 in The Lancet.

Elaine Coustan-Smith, of St. Jude Children's Research Hospital in Memphis, Tenn., and colleagues assessed leukemic cells from 239 patients with T-ALL using gene-expression profiling, flow cytometry and single-nucleotide polymorphism array analysis to determine the clinical outcome of lymphoid-cell-directed therapy.

Leukemic lymphoblasts with early T-cell precursor-related gene-expression signature were identified in 30 patients, the researchers found. Whereas 72 percent of patients in this group came out of remission or had a hematological relapse at 10 years, only 10 percent of patients with T-ALL did so, the study showed.

"Early T-cell precursor ALL is a distinct, previously unrecognized, pathobiological entity that confers a poor prognosis with use of standard intensive chemotherapy. Its early recognition, by use of the gene expression and immunophenotypic criteria outlined here, is essential for the development of an effective clinical management strategy," the authors write. "We have modified our approach to frontline treatment for patients with a diagnosis of early T-cell precursor ALL to include haemopoietic stem-cell transplantation in first remission after consolidation and reintensification therapy."

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