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Southwest Oncology Group Experience with Immunological Phenotyping in Acute Lymphocytic Leukemia of Childhood¹

Division of Pediatric Hematology-Oncology, Department of Pediatrics [D. J. P.], and Department of Preventive Medicine (Biostatistics) [E. F. M.], University of Mississippi Medical Center, Jackson, Mississippi 39216; Division of Pediatric Hematology-Oncology, Department of Pediatrics [J. M. F.], and Division of Immunology, Department of Microbiology and Immunology [B. D., R. S. M.], Duke University Medical Center, Durham, North Carolina 27710; Division of Pediatric Hematology-Oncology, Department of Pediatrics [W. M. C.], and Cellular Immunobiology Laboratory [L. B. V., M. D. C.], University of Alabama Medical Center, Birmingham, Alabama 35294; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190 [G. B. H., R. B.]; and Department of Pediatrics, M. D. Anderson Hospital and Tumor Institute, Houston, Texas 77030 [J. van E.]

The Pediatric Division of the Southwest Oncology Group is attempting to define subgroups of acute lymphoblastic leukemia (ALL) by laboratory delineation of marrow lymphoblast characteristics at diagnosis. Immunological subclassification studies include erythrocyte-forming rosette (E-rosette), C3 receptor, Fc receptor, surface immunoglobulin (Slg) and cytoplasmic immunoglobulin (Clg) determinations, as well as peripheral T (PT), thymocyte, la, and common ALL membrane antigen testing. Four subgroups of ALL have thus far been defined: null (Slg^-, Clg^-, PT^-); pre-B (Slg^-, Clg⁺, PT^-); B-cell (Slg⁺, Clg^-, PT^-); and T-cell (Slg^-, Clg^-, PT⁺). A group of 118 patients have had complete testing, and an additional 121 patients have had partial testing. Thirty-five patients with pre-B ALL and 27 patients with T-cell ALL have thus far been studied. Pre-B and null types of ALL appear closely related in multiple subclassification parameters (age, sex, physical findings, white blood cell count, and lymphoblast la and common ALL antigen positivity). Pre-B ALL patients treated with the same treatment regimens as were null ALL patients appear to have shorter durations of complete remission, although the difference has not yet reached statistical significance. Results suggest that the male predominance and older age distribution previously recognized for E-rosette-positive T-cell leukemia can also be expected in the E-rosette-intermediate and E-rosette-negative T-cell ALL subsets, although statistically higher white blood cell counts at diagnosis are seen in the E-rosette-positive subset. Mediastinal mass at diagnosis is most likely in the patient with E-rosette-positive, thymocyte antigen-positive lymphoblasts. The E-rosette-intermediate and E-rosette-negative, as well as the E-rosette-positive, T-cell ALL subsets appear to constitute poor prognosis categories. Correlation with treatment results is preliminary in all groups but suggests that stratification of ALL at diagnosis according to several immunological subgroupings may prove helpful in planning therapy.

¹ Presented at the Conference on Cell Markers in Acute Leukemia, March 4 and 5, 1980, Bethesda, Md. Supported in part by National Cancer Institute Grants CA-03161, CA-26756, CA-20549, CA-03096, CA-03713, CA-11233, CA-03389, CA-05587, CA-12213, CA-15989, CA-15525, CA-12644, CA-12014, CA-16943, CA-25408, and CA-16673.

² To whom requests for reprints should be addressed, at Pediatric Oncology Group, Operations Office, 4386 Lindell Boulevard, Second Floor, St. Louis, Missouri, 63108.