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
