Chromosomal abnormalities are established prognostic markers in adult ALL. We assessed the prognostic impact of established chromosomal abnormalities and key copy number alterations (CNA) among 652 patients with B-cell precursor ALL treated on a modern MRD driven protocol. Patients with KMT2A-AFF1, complex karyotype (CK) and low hypodiploidy/near-triploidy (HoTr) had high relapse rates 50%, 60% & 53% and correspondingly poor survival. Patients with BCR-ABL1 had an outcome similar to other patients. JAK-STAT abnormalities (CRLF2, JAK2) occurred in 6% patients and were associated with a high relapse rate (56%). Patients with ABL-class fusions were rare (1%). A small group of patients with ZNF384 fusions (n = 12) had very good survival. CNA affecting IKZF1, CDKN2A/B, PAX5, BTG1, ETV6, EBF1, RB1 and PAR1 were assessed in 436 patients. None of the individual deletions or profiles were associated with survival, either in the cohort overall or within key subgroups. Collectively these data indicate that primary genetic abnormalities are stronger prognostic markers than secondary deletions. We propose a revised UKALL genetic risk classification based on key established chromosomal abnormalities: (1) very high risk: CK, HoTr or JAK-STAT abnormalities; (2) high risk: KMT2A fusions; (3) Tyrosine kinase activating: BCR-ABL1 and ABL-class fusions; (4) standard risk: all other patients.

染色体异常是成人 ALL 的既定预后标志物。我们评估了 652 名接受现代 MRD 驱动方案治疗的 B 细胞前体 ALL 患者中已确定的染色体异常和关键拷贝数改变 (CNA) 的预后影响。具有KMT2A-AFF1、复杂核型 (CK) 和低亚二倍体/近三倍体 (HoTr) 的患者复发率高达 50%、60% 和 53%，且生存率相应较差。BCR-ABL1患者的结果与其他患者相似。JAK-STAT 异常（CRLF2、JAK2）发生在 6% 的患者中，并且与高复发率 (56%) 相关。ABL 级融合的患者很少见（1%）。一小群具有ZNF384融合的患者( n  = 12) 具有非常好的生存率。在 436 名患者中评估了影响IKZF1、CDKN2A/B、PAX5、BTG1、ETV6、EBF1、RB1和 PAR1的 CNA 。无论是在整个队列中还是在关键亚组中，任何个体删除或概况都与生存无关。总的来说，这些数据表明，原发性遗传异常是比继发性缺失更强的预后标志物。我们根据已确定的关键染色体异常提出修订后的 UKALL 遗传风险分类：(1) 极高风险：CK、HoTr 或 JAK-STAT 异常；(2)高风险：KMT2A融合；(3)酪氨酸激酶激活：BCR-ABL1和ABL类融合；(4)标准风险：所有其他患者。