E-rosette positive acute lymphoblastic leukaemia in adolescents and adults

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Abstract
E‐rosetting of leukaemic blast cells is one of the markers of T‐cell acute lymphoblastic leukaemia (ALL). In children, E+ ALL has a bad prognosis. In adults, data are scarce. This report provides information on 25 E+ ALL adult patients who have a minimum follow‐up time of 36 months. Twenty‐two of 25 patients (88%) achieved complete remission (CR) (median duration 16 months), and six of them were alive, relapse‐free, and off therapy after 36–81 months, with a 26% projected 6‐year relapse‐free survival. In 97 patients with E−SmIg− ALL, who were treated at the same Institutions, over the same period of time, and by the same modalities, the outcome of therapy was almost identical: CR 80%, median duration of first CR 15 months, projected 6‐year relapse‐free survival 15%. The white blood cell (WBC) count at presentation influenced significantly and to the same degree first CR length in both E+ and E− cases. In this adult series, WBC count was not as high as in children. Moreover, a high Hb concentration, a very high WBC count, lymphadenomegaly, and mediastinal involvement, were found more frequently in adolescents and young adults than in adults. Based on these data, it is suggested that in adults E‐rosetting as such is not a marker of a poorer prognosis, that some of the typical features of children E+ ALL weaken with age, and that in adults the disease can have a less aggressive character.