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/µL
- 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/µL
- Failure to achieve complete remission within 4 weeks
Table 1-Correlation between cytogenetic abnormalities and prognosis
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| 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% |
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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% |
