Early treatment response including PPR and MRD positive at day
46 are strong independent negative predictors for CDKN2A-deleted ALL
When monitoring for early treatment responses,results showed thatn=78
(71.3%)patients were PGR and n=110 (99.1%)patients achieved first
completeremission(CR).n=10 (41.6%) cases had PPR in T-ALL subgroup
while nosignificant differences between two
subgroups(P =0.148).There was no significant difference among the
two subgroups for other early treatment response factors.(Table 2)
By the end of follow-up,n=14 relapse(n=5 death after relapse),n=1
induction failure,n=1 death due to severe pneumonia(SP) and one patient
got second
malignancy(Langerhans
cell histiocytosis,LCH).Unfortunately, the patients got cutaneous
peripheral T-cell lymphoma soon after HLA identical
hematopoietic stem cell
transplantation(HSCT) and finally died from gastrointestinal and
pulmonary hemorrhage.The patient only had survived for 16 months after
the first diagnosis.It should be noted that the patient had no other
genetic abnormalities except CDKN2A deletion.
To test whether the co-variables described abovehad independent
prognostic value in CDKN2A-deleted patients,we performed univariate
analysis and multivariable analysis to assess their independent
predictive power for EFS (Table 3).Univariate analysis revealed that EFS
in CDKN2A-deleted ALL was associated with
CNS2,cytogenetic
risk groups,PPR,PER, and MRD≥0.01% at day 46(P <0.05)
while no significant difference was observed in age,sex, and WBC
counts.Seven variables(CNS2,WBC
counts≥50×109/L,cytogenetic risk groups,PPR,PER, and
MRD≥0.01% at day 19,46) were estimated by Cox regression models,results
showed both
PPR(HR=3.135,95%CI:1.138-8.638) and MRD positive at day
46(HR=3.812,95%CI: 1.388-10.464)wereindependent inferior prognostic
factors for event-free survival(P <0.05),suggesting the
adverse impact of these factors in CDKN2A-deleted ALL.(Table 4)