Classification and risk stratification in T-lineage acute lymphoblastic leukemia

Area of Science:

• Hematology
• Oncology
• Genetics

Background:

• Acute lymphoblastic leukemia (ALL) cure rates have significantly improved due to risk stratification.
• While effective for B-lineage ALL, risk stratification for T-lineage ALL (T-ALL) remains a challenge.
• Established T-ALL prognostic factors include age, CNS involvement, and MRD response.

Purpose of the Study:

• To review current challenges in T-ALL risk stratification.
• To highlight recent advances in identifying prognostic biomarkers for T-ALL.
• To underscore the potential of genomics in guiding future T-ALL treatment.

Main Methods:

• Review of clinical trials and real-world data in T-ALL.
• Analysis of immunophenotype and its association with T-ALL outcomes.
• Incorporation of recent large-scale genomic profiling data.

Main Results:

• Genomic profiling has identified multiple genetic subtypes and alterations in T-ALL.
• These genetic alterations are associated with outcomes independent of measurable residual disease (MRD).
• Immunophenotype, while used for classification, lacks consistent association with T-ALL outcomes in multivariable models.

Conclusions:

• Genomic classification holds significant potential for guiding future T-ALL treatment strategies.
• Ongoing efforts focus on identifying reliable prognostic biomarkers for T-ALL.
• Advances in genomics are crucial for refining risk stratification and improving T-ALL patient care.