4th Palermo Conference on INNOVATIVE THERAPIES FOR LYMPHOID MALIGNANCIES
Published online 22 September 2009
Haematologica, Vol 95, Issue 2, 324-328 doi:10.3324/haematol.2009.010306
Copyright © 2010 by Ferrata Storti Foundation
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Acute Lymphoblasic Leukemia

Adverse prognostic significance of CD20 expression in adults with Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia

Sébastien Maury, Françoise Huguet, Thibaut Leguay, Francis Lacombe, Marc Maynadié, Sandrine Girard, Adrienne de Labarthe, Emilienne Kuhlein, Emmanuel Raffoux, Xavier Thomas, Patrice Chevallier, Agnès Buzyn, André Delannoy, Yves Chalandon, Jean-Paul Vernant, Philippe Rousselot, Elizabeth Macintyre, Norbert Ifrah, Hervé Dombret, Marie-Christine Béné for the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)

The Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL) includes the former France-Belgium Group for Lymphoblastic Acute Leukemia in Adults (LALA), the French Western-Eastern Group for Lymphoblastic Acute Leukemia (GOELAL), and the Swiss Group for Clinical Cancer Research (SAKK)

Correspondence: Dr Sébastien Maury, Service d’Hématologie Clinique, CHU Henri Mondor, 51 av. du Mal de Lattre de Tassigny, 94010 Créteil cedex, France. Tel +33.149.812057, Fax +33.149.812067. E-mail: sebastien.maury{at}hmn.aphp.fr or Dr Marie-Christine Béné, Immunology Laboratory, CHU Nancy & Nancy Universite, 9 Allée du Morvan, 54500 Vandoeuvre les Nancy, France. Tel +33.383.157615, Fax +33.383.157660. E-mail: bene{at}medecine.uhp-nancy.fr

The prognostic significance of CD20 expression in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has been mostly studied in children and yielded conflicting results. In 143 adults with Philadelphia chromosome-negative BCP-ALL treated in the multicentric GRAALL 2003 trial, CD20 positivity over 20% was observed in 32% of patients. While not influencing complete remission achievement, CD20 expression was associated with a higher cumulative incidence of relapse (CIR) at 42 months (P=0.04), independently of the ALL high-risk subset (P=0.025). Notably, the negative impact of CD20 expression on CIR was only observed in patients with a white blood cell count (WBC) over 30x109/L (P=0.006), while not in those with a lower WBC. In the former subgroup, this impact translated into lower event-free survival (15% vs. 59% at 42 months, P=0.003). CD20 expression thus appears to be associated with a worse outcome, which reinforces the interest of evaluating rituximab combined to chemotherapy in CD20-positive adult BCP-ALL. ClinicalTrials.gov ID, NCT00222027.

Key words: CD20, acute lymphoblastic leukemia, rituximab, prognosis.