Prognostic significance of terminal deoxynucleotidyl transferase activity in acute nonlymphoblastic leukemia

P. Benedetto, R. Mertelsmann, T. H. Szatrowski, M. Andreeff, T. Gee, Z. Arlin, S. Kempin, B. Clarkson

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41 Scopus citations


Bone marrow and/or peripheral blood samples from 133 (75%) of a total of 177 consecutive previously untreated protocol patients with acute nonlymphoblastic leukemia (ANLL) were analyzed for terminal deoxynucleotidyl transferase (TdT) activity at the time of presentation. Twenty-nine (22%) were found to exhibit TdT activity (≥ 0.10 U/108 cells, TdT+) as measured in a biochemical microassay. There were no differences between TdT+ as compared with TdT-negative (TdT-) patients with respect to age, sex, French-American-British (FAB) classification, or the presence of Auer's rods. Remission induction rates were higher for the TdT- patients, with 68% v 48% for the TdT+ patients (P = .05). TdT- patients also experienced longer remissions (P = .003) than TdT+ patients, especially in the Auer's rod-positive subgroup (P = .002). None of five patients with TdT+ ANLL treated with vincristine and prednisone as initial therapy achieved complete remission; all required induction regimens containing daunorubicin or amsacrine in combination with cytosine arabinoside and 6-thioguanine. It is concluded that TdT activity in ANLL indicates biphenotypia or lineage infidelity and is associated with a poor prognosis on chemotherapy protocols currently used for the treatment of ANLL.

Original languageEnglish (US)
Pages (from-to)489-495
Number of pages7
JournalJournal of Clinical Oncology
Issue number4
StatePublished - Jan 1 1986
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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