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Precursor T-Cell Acute Lymphoblastic Leukemia in Adults
Age-Related Immunophenotypic, Cytogenetic, and Molecular Subsets

Mihaela Onciu MD, Raymond Lai MD, PhD, Francisco Vega MD, Carlos Bueso-Ramos MD, PhD, L. Jeffrey Medeiros MD
DOI: http://dx.doi.org/10.1309/08DJ-GPBH-H0VR-RC6F 252-258 First published online: 1 February 2002


We analyzed the clinicopathologic and molecular findings in 26 adults (age 16–72 years) with T-cell acute lymphoblastic leukemia (T-ALL) and observed features that correlated with age. Patients older than 60 years (n = 5) had a low frequency of hepatosplenomegaly (0 [0%]), anterior mediastinal mass (1 [20%]), and lymphadenopathy (2 [40%]), and completely responded to chemotherapy (4 of 4). The T-ALL in this group commonly expressed myeloid antigens (4 [80%]), had lineage-inappropriate gene rearrangements (2/3 [67%]) and chromosome 2 deletion (3/4 [75%]), and exclusively used the VIII or VIV families of the T-cell receptor (TCR) gamma gene. In comparison, patients 16 to 60 years old (n = 21) more commonly had an anterior mediastinal mass (8 [38%]), hepatosplenomegaly (10 [48%]), and lymphadenopathy (16 [76%]). The tumors in these patients commonly used the TCR gamma gene VI or VII families (17/25 total rearrangements [68%]). Myeloid antigen expression (5 [24%]) and lineage inappropriate gene rearrangements (4/15 [27%]) were uncommon. Within this group, CD1a expression correlated with age 28 to 60 years. These results illustrate considerable age-related heterogeneity in adult T-ALL, which may reflect differences in tumor cell maturation.

Key Words:
  • T-cell acute lymphoblastic leukemia
  • Adults
  • Immunophenotype
  • Cytogenetics
  • Molecular studies