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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EGood management of patients with T-lymphoblastic leukemia requires identifying those at higher risk of morbidity and mortality. End-induction minimal residual disease appears to be a useful tool for predicting outcome and managing treatment, while classifying patients according to the presence of early thymic precursor immunophenotype does not improve risk assessment.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Echildren\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ET-cell acute lymphoblastic leukemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eend-induction minimal residual disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eearly thymic precursor immunophenotype\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group drug\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAALL0434\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECombination Chemotherapy in Treating Young Patients With Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia or T-cell Lymphoblastic Lymphoma [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00408005\u0026amp;atom=%2Fspmdc%2F14%2F55%2F5.atom\u0022\u003ENCT00408005\u003C\/a\u003E]\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EChildren with T-cell acute lymphoblastic leukemia (T-ALL) have excellent outcomes after treatment with AALL0434, a standard 4-drug induction therapy. End-induction minimal residual disease (MRD) was more important in predicting treatment response than the early thymic precursor (ETP) immunophenotype, according to the results from the Combination Chemotherapy in Treating Young Patients With Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia or T-Cell Lymphoblastic Lymphoma [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00408005\u0026amp;atom=%2Fspmdc%2F14%2F55%2F5.atom\u0022\u003ENCT00408005\u003C\/a\u003E] trial presented by Brent L. Wood, MD, PhD, University of Washington, Seattle, Washington, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe phase 3 trial enrolled 1895 patients (aged 1 to 30 years) with T-ALL. The prognostic impact of MRD was measured by 8- and 9-color flow cytometry in the peripheral blood at day 8 and in bone marrow at end of induction (day 29), and end of consolidation was compared with prognostic ability of ETP status assessed at diagnosis. AALL0434 therapy consisted of prednisone for 28 days, vincristine weekly for 4 weeks, pegaspargase on day 4, and daunorubicin weekly for 4 weeks. An initial subset of cases confirmed that near ETP meets ETP criteria except for elevated CD5 B-cells.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAn initial subset of thymocytes, ETP, retains stem-cell-like features, as reviewed by Coustan-Smith and colleagues [\u003Cem\u003ELancet Oncol\u003C\/em\u003E. 2009], who helped to define criteria for standardization in the AALL0434 study. The presence of ETP cells in patients with T-ALL confers a poor prognosis with use of standard intensive chemotherapy. Thus, early recognition is believed essential for the development of an effective clinical management strategy.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn the AALL0434 study, ETP, near ETP, and not ETP were noted in 11.3%, 17.0%, and 71.6% of patients, respectively. At day 29, MRD\u2009\u0026lt;\u20090.01% was significantly more evident in the group without ETP compared with those with ETP or near ETP (\u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.0001). Induction failure, defined as \u0026gt;\u200935% blasts by morphology in bone marrow at day 29, was proportionally more evident in the group with ETP (45.5%) and near ETP (48.1%) compared with not ETP (11.2%). However, percentage outcomes for 4-year event-free survival (EFS) and overall survival (OS) were similar regardless of the subtype (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11646\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11646\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11646\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EETP Subtype Does Not Affect EFS or OS Outcome\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EMRD is an important predictor of relapse in children with T-ALL. An MRD day 29 risk \u0026lt;\u20090.1% was considered low risk, \u0026lt;\u20091.0% intermediate, and \u2265\u20091.0% high. An MRD D29 \u0026lt;\u20090.01% to \u0026lt;\u200910.0% was associated with a higher probability of EFS and OS compared with an MRD D29 \u2265\u200910%. EFS and OS were similar regardless of the ETP subtype.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EPatients with MRD\u2009\u2265\u20090.1% at the end of consolidation fared poorly (\u003Cem\u003EP\u003C\/em\u003E\u2009\u0026lt;\u2009.0001) compared with those with MRD\u2009\u0026lt;\u20090.1%. Early (day 8) blast clearance from peripheral blood was associated with significantly better outcomes (\u003Cem\u003EP\u2009\u003C\/em\u003E\u0026lt;\u2009.02). However, it did not identify poor risk among the \u0026lt;\u20090.01% MRD D29 subset. In addition, a white blood cell count\u2009\u2265\u2009200\u2009000 was associated with worse outcome with near ETP (\u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.003) and not ETP (\u003Cem\u003EP\u003C\/em\u003E\u2009=\u2009.012), whereas frequency was low with ETP. Off-protocol therapy events at the end of induction and during consolidation appeared similar among the subtypes. No preferential attrition (15% to 20% on Children\u2019s Oncology Group ALL trials) by MRD stratification at the end of induction was seen among ETP subtypes.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/55\/5.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo942\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzo942\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}