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>10-3after induction

>10-4 or increasing during first year of therapy

aRemains to be validated in a large, prospective series.

aRemains to be validated in a large, prospective series.

CYTOGENETICS/MOLECULAR GENETICS

Cytogenetic abnormalities occur in about 60-70% of adults with ALL and are among the most important prognostic factors; therefore, cytogenetic analysis is a critical component of the diagnostic workup.1421 The Cancer and Leukemia Group B (CALGB) stratified patients into three prognostic groups based on cytogenetics: poor [including t(9;22), t(4;11), -7, and + 8]; normal diploid; and miscellaneous (all other structural aberrations), with DFS rates of 11, 38, and 52%, respectively.29 In this series, a higher frequency (35%) of patients with precursor T ALL had a normal karyotype. In particular, all larger series have identified that the presence of the Philadelphia chromosome, t(9;22) (q34;q11), and translocations involving the MLL gene on chromosome 11q23—the most common of which is the t(4;11)(q21;q23)—are independently associated with short CR duration and survival.202130 The Philadelphia chromosome is the most common recurring abnormality (overall 25-30%) in adult ALL, and it increases in frequency with age. Allogeneic stem cell transplantation (allo SCT) in first remission is advocated for these high-risk patients and is discussed below. In contrast, patients with precursor T ALL and the t(10;14) appear to have durable remissions.5

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