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Acute Lymphoblastic Leukemia

 

 

 

Prognosis

 

The prognosis of ALL is generally good with an overall event free survival of 70 - 80%.

Prognostic factors determine the type of therapy given.

Risk-based treatment protocols have been developed which depend on different clinical and laboratory prognostic features.  These can be categorized:

  • Patient characteristics at diagnosis
  • Leukemia characteristics at diagnosis
  • Response to therapy

 

There are some subgroups of patients who have an event free survival of less than 45%.

These patients have a very high risk of treatment failure and receive intensive therapy.  They include:

  • Patient characteristics at diagnosis:
    • Infants with ALL have a very high risk of treatment failure
  • Leukemia characteristics at diagnosis
    • Patients with Ph+ ALL
    • Intrachromosomal amplification of chromosome 21 (iAMP21)
    • Hypodiploid patients with <44 chromosomes and/or DNA index of less than 0.8.
    • MLL rearrangement with a slow early response to induction chemotherapy (M2/M3 marrow at Day 15 and/or minimal residual disease (MRD) levels ≥ 0.1% at the end of induction.
  • Response to therapy
    • Patients who had an M3 (> 25% blasts) bone marrow at the end of induction therapy
    • Patients who have M2 (5–25% blasts by histology and/or minimal residual disease as defined by ≥1% blasts by immunophenotyping) marrow at the end of induction therapy and do not achieve an M1 (<5% blasts by histology or <1% marrow blasts by immunophenotyping) marrow by the end of an extended induction period or by the end of consolidation.

 

External link:

ALL: Cellular Classification and Prognostic Variables at the NCI

    

 

 

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