1. Integrated genetic and clinical prognostic factors for aggressive adult T-cell leukemia/lymphoma
- Author
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70866582, Kameda, Takuro, Kataoka, Keisuke, Kamiunten, Ayako, Hidaka, Michihiro, Miyoshi, Hiroaki, Nakano, Nobuaki, Nosaka, Kisato, Yoshimitsu, Makoto, Yasunaga, Jun-Ichirou, Kogure, Yasunori, Shide, Kotaro, Miyahara, Masaharu, Sakamoto, Takashi, Akizuki, Keiichi, Hidaka, Tomonori, Kubuki, Yoko, Koya, Junji, Kawano, Noriaki, Yamashita, Kiyoshi, Kawano, Hiroshi, Toyama, Takanori, Maeda, Kouichi, Marutsuka, Kosuke, Imaizumi, Yoshitaka, Kato, Koji, Sugio, Takeshi, Tokunaga, Masahito, Tashiro, Yukie, Takaori-Kondo, Akifumi, Miyazaki, Yasushi, Akashi, Koichi, Ishitsuka, Kenji, Matsuoka, Masao, Ohshima, Koichi, Watanabe, Toshiki, Kitanaka, Akira, Utsunomiya, Atae, Ogawa, Seishi, Shimoda, Kazuya, 70866582, Kameda, Takuro, Kataoka, Keisuke, Kamiunten, Ayako, Hidaka, Michihiro, Miyoshi, Hiroaki, Nakano, Nobuaki, Nosaka, Kisato, Yoshimitsu, Makoto, Yasunaga, Jun-Ichirou, Kogure, Yasunori, Shide, Kotaro, Miyahara, Masaharu, Sakamoto, Takashi, Akizuki, Keiichi, Hidaka, Tomonori, Kubuki, Yoko, Koya, Junji, Kawano, Noriaki, Yamashita, Kiyoshi, Kawano, Hiroshi, Toyama, Takanori, Maeda, Kouichi, Marutsuka, Kosuke, Imaizumi, Yoshitaka, Kato, Koji, Sugio, Takeshi, Tokunaga, Masahito, Tashiro, Yukie, Takaori-Kondo, Akifumi, Miyazaki, Yasushi, Akashi, Koichi, Ishitsuka, Kenji, Matsuoka, Masao, Ohshima, Koichi, Watanabe, Toshiki, Kitanaka, Akira, Utsunomiya, Atae, Ogawa, Seishi, and Shimoda, Kazuya
- Abstract
The prognosis of aggressive adult T-cell leukemia/lymphoma (ATL) is poor, and allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is a curative treatment. To identify favorable prognostic patients after intensive chemotherapy, and who therefore might not require upfront allo-HSCT, we aimed to improve risk stratification of aggressive ATL patients aged <70 years. The clinical risk factors and genetic mutations were incorporated into risk modeling for overall survival (OS). We generated the m7-ATLPI, a clinicogenetic risk model for OS, that included the ATL prognostic index (PI) (ATL-PI) risk category, and non-silent mutations in seven genes, namely TP53, IRF4, RHOA, PRKCB, CARD11, CCR7, and GATA3. In the training cohort of 99 patients, the m7-ATLPI identified a low-, intermediate-, and high-risk group with 2-year OS of 100%, 43%, and 19%, respectively (hazard ratio [HR] 5.46, p < 0.0001). The m7-ATLPI achieved superior risk stratification compared to the current ATL-PI (C-index 0.92 vs. 0.85, respectively). In the validation cohort of 84 patients, the m7-ATLPI defined low-, intermediate-, and high-risk groups with a 2-year OS of 81%, 30%, and 0%, respectively (HR 2.33, p = 0.0094), and the model again outperformed the ATL-PI (C-index 0.72 vs. 0.70, respectively). The simplified m7-ATLPI, which is easier to use in clinical practice, achieved superior risk stratification compared to the ATL-PI, as did the original m7-ATLPI; the simplified version was calculated by summing the following: high-risk ATL-PI category (+10), low-risk ATL-PI category (−4), and non-silent mutations in TP53 (+4), IRF4 (+3), RHOA (+1), PRKCB (+1), CARD11 (+0.5), CCR7 (−2), and GATA3 (−3).
- Published
- 2023