Table 2.
Characteristics of patients with B-ALL post MM from selected references.
| Reference | Number of patients in study | Age, sex | Multiple myeloma (MM) genetic features | Duration of lenalidomide maintenance prior to B-ALL (months) | Time from MM to B-ALL | B-ALL presentation | Karyotype / molecular | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Parrondo RD et al. - 10 | 14 | Mean 63.9 yrs, 29% male | In 12 patients, median duration 53 months (range 17–121) | In 12 patients, median time to develop B-ALL 61 months (range 17–123 months) | Hypodiploidy/near triploidy 43%, hyperdiploidy 14%, normal karyotype 7%, complex karyotype 14% | HyperCVAD 71%, transplant in CR1 71% | MRD+ 4/12 pts, death after ALL diagnosis 4/14 pts, death after transplant 2/11 pts, relapse 1/14 pts, non-relapse mortality after transplant 2/11 pts | ||
| Khan A et al. – 14 | 2 | Pt 1 – 53F, pt 2 – 69F | Pt 1 - 6 yrs, pt 2 - 15 months | Pt 1 - trisomies 8,10,21, monosomy 20; pt 2 – t(7;19) in one cell | Pt 1 -CALGB study 8811, pt 2 - HyperCVAD | Pt 1 - In remission at 12 months; Pt 2 – in remission at 36 months but 6% abnormal plasma cells |
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| Germans SK et al. – 15 | 2 | Pt 1 – 64 M, Pt 2 – 43M | Pt 1 - Biclonal myeloma with high risk features (del13q and del TP53); Pt 2 – t(4;14), aneuploidy 9 and 15 |
Pt 1 - 21 months; Pt 2 – 75 months | Pt 1 - 25 months; Pt 2 – 83 months | Pt 1 - 5% B-lymphoblasts first classified as hematogones | Pt 1 - Shared abnormalities with MM clone (del13q14, del TP53), additional abnormalities associated with MM including loss of FGFR, MAF; Pt 2 – TP53 mutation, loss of function CREBBP variant | Pt 1 – HyperCVAD; Pt 2 – HyperCVAD x 4 cycles, inotuzumab after relapse | Pt 1 - remission at 17 months, residual TP53 mutation; Pt 2 – death from ALL 23 months after diagnosis |
| Garcia-Munoz R et al. - 16 | 1 | 62F | 20 months | Normal karyotype | Induction therapy | Died during induction from septicemia | |||
| Li J et al. - 17 | 1 | 66M | 31 months (thalidomide) | 38 months | add(4)(P16) | CHOP | Died of ALL | ||
| Tan M et al. – 18 | 3 | Pt 1 - 59 M, Pt 2 – 34 M, Pt 3 – 53M | Pt 1 – 2.5 yrs, Pt 2 – 3 yrs, Pt 3 – 7 yrs | Pt 1 - del20q, Pt 2 – abnormality of chromosome 14, Pt 3 – small population of tetraploid cells | Pt 1 - Modified Linker regimen, alloSCT, Pt 2 – CALGB 8811, Pt 3 – modified Linker regimen followed by SCT | Pt 1 – in remission 1 year post transplant; Pt 2 – deceased 1 month post ALL; Pt 3 – remission 1 year post alloSCT |
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| Gonzalez MM et al. - 21 | 1 | 72M | 46XY[20]/+55XY,+9mar[1] | 8 years | Concomitant acute myelofibrosis | HyperCVAD | Relapsed B-ALL at 28 months | ||
| Tashakori M et al. – 22 | 1 | 65F | 5 years | Trisomy 8, 2 TP53 missense mutations | |||||
| Mei J et al. – 24 | 2 | Pt 1 - 68 M, Pt 2 – 65F | Pt 1 – 2 yrs, Pt 2 – 5 yrs | Pt 2 – hypodiploid and complex karyotype | Pt 1 – declined therapy, Pt 2 – low dose chemotherapy | Pt 1 – died 4 months after ALL diagnosis, Pt 2 - died 1 month after ALL diagnosis | |||
| Sinit RB et al. – 25 | 1 | 67M | 15 yrs | Bone marrow biopsy with 20% MM, 60% B-ALL | Trisomies 8 and 21, near tetraploidy; plasma cells with TP53 deletion, trisomies 3,7,11, trisomies/tetrasomies 9,15 | Inotuzumab at B-ALL relapse | Stable M-protein and no circulating blasts 15 months post diagnosis | ||
| Lee HY et al. – 26 | 2 | Pt 1 - 54 M, Pt 2 – 54F | Pt 1 – normal karyotype; Pt 2 - 52,XX,+add(3)(q12),+5,−6,−8,+9,−10,+11,+15,−17,+18,+19,+20,−22,+3mar [2]/46, XY[7] | Pt 1 - 8 yrs, Pt 2 – 8 yrs | Pt 1 −45,XY,−7,1dmin[14]/46,XY,−7,+21,1dmin[5]/46,XY[1], Pt 2 – normal karyotype | Pt 2 – HyperCVAD x 6 | Pt 1 - Remission after induction and 2 cycles of consolidation; Pt 2 - remission | ||
| Aldoss I et al. – 27 | 13 | 60 yrs (range 43–67), 62% male | 5.4 yrs (range 3.3–10) | Normal karyotype – 5 pts, TP53 mutation / deletion – 3 pts, monosomy 7 / del7q – 2 pts | HyperCVAD (12/13 pts) | 85% complete remission, 8/13 pts went to alloSCT, one year event free survival and overall survival were 77% | |||
| Konishi Y et al. – 28 | 1 | 54M | 8 yrs | t(X;9;1)(q12:q34:p34) | hyperCVAD, alloSCT | Remission from ALL at 3 years, detectable serum M-protein | |||
| Piszcz J et al. – 29 | 1 | 56F | 9 yrs | Normal karyotype | Conservative management due to comorbidities | Died after 10 days of conservative management |
Abbreviations: M, F, male, female; Pt, patient; FISH, Fluorescence in situ hybridization; alloSCT, allogeneic hematopoietic stem cell transplant; yrs, years; HyperCVAD, cyclophosphamide, vincristine, doxorubicin (adriamycin), and dexamethasone; MRD, minimal residual disease; CHOP, cyclophosphamide, doxorubicin, vincristine, prednisone.