Prognostic heterogeneity of adult B-cell precursor acute lymphoblastic leukaemia patients with t(1;19)(q23;p13)/ TCF3-PBX1 treated with measurable residual disease-oriented protocols

The prognosis of t(1;19)(q23;p13)/transcription factor 3-pre-B-cell leukaemia homeobox 1 (TCF3-PBXI) in adolescent and adult patients with acute lymphoblastic leukaemia (ALL) treated with measurable residual disease (MRD)-oriented trials remains controversial. In the present study, we analysed the outcome of adolescent and adult patients with t(1;19)(q23;p13) enrolled in paediatric-inspired trials. The patients with TCF3-PBXI showed similar MRD clearance and did not have different survival compared with other B-cell precursor ALL patients. However, patients with TCF3-PBXI had a significantly higher cumulative incidence of relapse, especially among patients aged >= 35 years carrying additional cytogenetic alterations. These patients might benefit from additional/intensified therapy (e.g. immunotherapy in first complete remission with or without subsequent haematopoietic stem cell transplantation).

Automated summary

The prognosis of adolescent and adult patients with t(1;19)(q23;p13) translocation remains controversial in MRD-oriented trials. Patients with TCF3-PBXI show similar MRD clearance and survival rates compared to other B-cell precursor ALL patients, but have a significantly higher cumulative incidence of relapse, especially in older patients with additional cytogenetic alterations. These patients may benefit from additional or intensified therapy such as immunotherapy followed by hematopoietic stem cell transplantation.