Allogeneic hematopoietic stem cell transplantation overcome the poor prognosis of patients with IKZF1plus CD20-a very high-risk subtype in B-cell acute lymphoblastic leukemia

作者：Tang, Bingqing; Cai, Zihong; Wang, Zhixiang; Lin, Dainan; He, Xianjun; Li, Qiuli; Liang, Xiaojie; Huang, Kangyu; Zhou, Xuan; Lin, Ren; Xu, Na; Fan, Zhiping; Huang, Fen; Sun, Jing; Liu, Xiaoli; Liu, Qifa^*; Zhou, Hongsheng^*

来源：Bone Marrow Transplantation, 2022, 57(12): 1751-1757.

DOI：10.1038/s41409-022-01797-1

• CLINICAL IMPACT
• DELETIONS
• ADULTS

Genetic deletions of IKZF1 (IKZF1(del)) and IKZF1(del) plus other mutations (IKZF1(plus)) have been identified in B-cell acute lymphoblastic leukemia (B-ALL) with a poor prognosis. Herein, we investigated the combination of IKZF1(del) and CD20 immunotypes in adult patients with B-ALL in the PDT-ALL-2016 cohort. This study cohort consisted of 161 patients with B-ALL with detailed information on IKZF1(del) and CD20 expression. The independent cohort included 196 patients from the TARGET dataset. IKZF1(del) was detected in 36.0% of patients with 3-year event-free survival (EFS) of 37.1 +/- 6.7% and overall survival (OS) of 51.5 +/- 7.3%, compared to IKZF1 wild-type (IKZF1(wt)) with an EFS 55.3 +/- 5.1% (P = 0.011) and OS 74.4 +/- 4.5% (P = 0.013), respectively. CD20-positive (CD20(+)) was associated with inferior EFS compared to the CD20-negative (CD20(-)) group (P = 0.020). Furthermore, IKZF1(del) coupled with CD20+, IKZF1(del)/CD20(+), comprised 12.4% of patients with a 3-year EFS of 25.0 +/- 9.7%, compared with IKZF1(wt)/CD20(-) (P <= 0.001) and IKZF1(del)/CD20(-) (P = 0.047) groups. Multivariable analyses demonstrated the independence of IKZF1(del)/CD20(+), with the highest predicted hazard ratio for EFS and OS. Furthermore, the prognostic panel of IKZF1(del)/CD20(+) was confirmed in the TARGET cohort. Notably, neither the IKZF1(del), CD20(+), or IKZF1(del)/CD20(+) groups were identified to have poor outcomes in the cohort of allogeneic hematopoietic stem cell transplantation (n = 81).Collectively, our data define IKZF1(del)/CD20(+) as a very high-risk subtype in B-ALL, and allo-HSCT could abrogate the poor outcome of both IKZF1(del) and IKZF1(del)/CD20(+) subsets.

• 单位
  南方医科大学