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Acute lymphoblastic leukemia

Good prognosis or poor prognosis, dose-intensive or less intensive: who decides for adults with T-lymphoblastic lymphoma/leukemia

Leukemia volume 34, pages 3075–3076 (2020)Cite this article

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T-cell lymphoblastic lymphoma (T-LBL) is an aggressive malignancy arising from precursor T cells that occurs mostly in adolescents and young adults, comprising ~2% of all non-Hodgkin’s lymphomas (NHL) patients [1, 2]. Due to the scarcity of this disease, genomic and proteomic biomarkers definitely associated with prognosis and treatment response or drug resistance have not been well recognized. The commonly used prognostic factors, such as typical clinical factors, radiographic findings, and specific molecular biomarkers, have not shown consistent prognostic performance across various studies in the world [3, 4]. Though the prognosis of childhood T-LBL has been significantly improved during the past 10 years due to few emerging new regimens [4], adults with T-LBL have fared poorly in response and outcome, partially due to greater genetic heterogeneity and vunerable tolerance of intensive chemotherapy. Acute lymphoblastic leukemia (ALL)-like chemotherapies, including BFM protocol and hyperCVAD regimen, have been widely used, with the latter one less intensive and slightly better tolerated by adult patients. However, great challenge exists concerning who deem to have good prognosis and should receive less intensive treatment.

We read with interest the impressive paper by Xiaopeng Tian et al, published in Leukemia in the recent 2020 February issue [5]. In this study, an eleven-gene-based signature was established in a large cohort of 613 patients with T-LBL/ALL from 28 medical centers across China academic centers. This mRNA signature had excellent performance in predicting the survival outcomes of adults with T-LBL. Of more interest to clinical physicians, a nomogram based on this gene signature with other clinicopathological variables was constructed, which could identify those who really benefited from the intensive BFM protocol, thus maximizing the efficacy and minimizing the toxicities in the specific patient populations.

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  1. Duke University Medical Center, Division of Hematopathology and Department of Pathology, Duke University Cancer Institute, Durham, NC, USA

    Ken H. Young

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Young, K.H. Good prognosis or poor prognosis, dose-intensive or less intensive: who decides for adults with T-lymphoblastic lymphoma/leukemia. Leukemia 34, 3075–3076 (2020). https://doi.org/10.1038/s41375-020-0861-6

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