CRLF2 over-expression is a poor prognostic marker in children with high risk T-cell acute lymphoblastic leukemia

Chiara Palmi, Angela M. Savino, Daniela Silvestri, Ilaria Bronzini, Gunnar Cario, Maddalena Paganin, Barbara Buldini, Marta Galbiati, Martina U. Muckenthaler, Cristina Bugarin, Pamela Della Mina, Stefan Nagel, Elena Barisone, Fiorina Casale, Franco Locatelli, Luca Lo Nigro, Concetta Micalizzi, Rosanna Parasole, Andrea Pession, Maria C. PuttiNicola Santoro, Anna M. Testi, Ottavio Ziino, Andreas E. Kulozik, Martin Zimmermann, Martin Schrappe, Antonello Villa, Giuseppe Gaipa, Giuseppe Basso, Andrea Biondi, Maria G. Valsecchi, Martin Stanulla, Valentino Conter, Geertruy te Kronnie, Giovanni Cazzaniga*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Pediatric T-ALL patients have a worse outcome compared to BCP-ALL patients and they could benefit from new prognostic marker identification. Alteration of CRLF2 gene, a hallmark correlated with poor outcome in BCP-ALL, has not been reported in T-ALL. We analyzed CRLF2 expression in 212 T-ALL pediatric patients enrolled in AIEOP-BFM ALL2000 study in Italian and German centers. Seventeen out of 120 (14.2%) Italian patients presented CRLF2 mRNA expression 5 times higher than the median (CRLF2-high); they had a significantly inferior event-free survival (41.2%±11.9 vs. 68.9%±4.6, p=0.006) and overall survival (47.1%±12.1 vs. 73.8%±4.3, p=0.009) and an increased cumulative incidence of relapse/resistance (52.9%±12.1 vs. 26.2%±4.3, p=0.007) compared to CRLF2-low patients. The prognostic value of CRLF2 over-expression was validated in the German cohort. Of note, CRLF2 over-expression was associated with poor prognosis in the high risk (HR) subgroup where CRLF2-high patients were more frequently allocated. Interestingly, although in T-ALL CRLF2 protein was localized mainly in the cytoplasm, in CRLF2-high blasts we found a trend towards a stronger TSLP-induced pSTAT5 response, sensitive to the JAK inhibitor Ruxolitinib. In conclusion, CRLF2 over-expression is a poor prognostic marker identifying a subset of HR T-ALL patients that could benefit from alternative therapy, potentially targeting the CRLF2 pathway.

Original languageEnglish
Pages (from-to)59260-59272
Number of pages13
Issue number37
StatePublished - 2016
Externally publishedYes


  • CRLF2
  • High risk
  • Pediatric leukemia
  • Prognostic marker
  • T acute lymphoblastic leukemia


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