Acute Lymphoblastic Leukemia - Prognosis

Prognosis

Prognosis of the ALL patient depends on several parameters. Younger patients have better chances of survival compared to older ones.


Patients with ALL are divided into 3 prognostic groups-

Favorable prognosis group includes:

• No adverse cytogenetic abnormalities
• Age younger than 30 years
• WBC count of less than 30,000/�L
• Complete remission within 4 weeks.

Intermediate risk group does not meet the criteria for either good risk or poor risk.

Poor risk group includes:

• Adverse cytogenetics [(t9; 22), (4; 11) genetic translocations]
• Age older than 60 years
• Precursor B-cell WBCs with WBC count greater than 100,000/�L
• Failure to achieve complete remission within 4 weeks

Table 1-Correlation between cytogenetic abnormalities and prognosis

Cytogenetic Abnormality	Genes Involved	Event-Free Survival (3 yrs)
t(10;14)(q24;q11)	HOX11/TCRA	75%
6q	Not Known	47%
14q11	TCRA/TCRD	42%
11q23	MLL	18-26%
9p	Not Known	22%
12	TEL	20%
t(1;19)(q23;p13)	PBX1/E2A	20%
t(8;14)(q24;q23) t(2;8)(p12;q24) t(8;22)(q24;q11)	c-myc/IGH IGK/c-myc c-myc/IGL	17%
t(9;22)(q34;q11) Philadelphia chromosome	bcr-abl	5-10%
t(4;11)(q21;q23)	AF4-MLL	0-10%

Table 2. Correlation between Ploidy (Chromosome Number) and Prognosis

Ploidy	Event-Free Survival(3 yrs)
Near tetraploidy	46-56%
Diploidy(Normal karyotype)	34-44%
Hyperdiploidy >50	32-59%
Hyperdiploidy 47-50	21-53%
Pseudodiploidy	12-25%
Hypodiploidy	11%

References:

1. Pui CH. Acute lymphoblastic leukemia. Pediatr Clin North Am 1997; 4: 831-846.
2. Pui CH, Evans WE. Acute lymphoblastic leukemia. N Engl J Med 1998; 339: 605-615.
3. Gurney JG, Severson RK, Davis S, Robinson L. Incidence of cancer in children in the United States. Cancer 1995; 75: 2186-2195.
4. Young J, Gloeckler RL, Silverberg E, Horm J, Miller R. Cancer incidence, survival and mortality for children younger than age 15 years. Cancer 1986; 58: 598-602.

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