Acute Lymphoblastic Leukemia Prognosis

By Dr Ananya Mandal, MD

Acute lymphoblastic leukemia has a good outlook or prognosis in children but a poorer outlook in adults. Infant variety of ALL however has a poor prognosis.

Survival rates

Over the past forty years the rates of survival have changed from 0% to 20-75 percent currently. This is mainly due to advances in chemotherapy and efficacy and safety of novel therapies like bone marrow transplantation and stem cell transplants.

What determines a good prognosis?

There are some common factors that determine a good prognosis. This includes gender. Females tend to survive better after therapy than males for example.

Genetics is another important factor. This is partly determined by ethnicity or race. Caucasians are more likely to develop acute leukemia than African-Americans, Asians and Hispanics. Caucasians are also more likely to respond to therapy and have a better prognosis than others.

Patients with genetic disorders like Down’s syndrome often respond poorly to therapy and may have a poor outlook.

Survival chances

Patients are divided into three groups on the basis of their survival chances. This includes:-

  1. Those with a bad prognosis or outlook - these patients usually have a set of one or more criteria. These include:-
    1. Unfavourable or adverse cytogenetics. This includes cytogenetics like (t9;22), (4;11). Translocation between 9:22 is more common among adults and carries a poor prognosis. Translocation between 4:11 occurs rarely in about 4% of cases and is most common in infants under 12 months. It carries a poor prognosis. t(8;14)(q24.1;q32) also carries a poor prognosis. Hypodiploidy-near haploidy; Near tetraploidy; del (17p); t (9;22); t (11q23) tends to have a poor prognosis.
    2. Age over 60 years
    3. Precursor B-cells with WBC count over 100 x 109/L
    4. Failure to achieve complete remission within four weeks of starting therapy
    5. Spread to brain, central nervous system and other involvement of other major organs
  2. Those with a good outlook – these patients usually have a set of one or more criteria. These include:-
    1. Favorable cytogentic features. Hyperdiploidy > 50 ; t (12;21) carries a favourable prognosis.
    2. Age less than 30 years
    3. Total white blood cell counts of less than 30 x 109/L
    4. Within 4 weeks of initiating therapy complete remission is achieved.
  3. Those who do not fit any of the above criteria are considered to be of intermediate prognosis. Hyperdioloidy 47 -50; Normal(diploidy); del (6q); Rearrangements of 8q24 carries an intermediate prognosis. Unclassified ALL is considered to have an intermediate prognosis

Reviewed by April Cashin-Garbutt, BA Hons (Cantab)

Sources

  1. http://www.nhs.uk/Conditions/Leukaemia-acute-lymphoblastic/Pages/Diagnosis.aspx
  2. http://www.patient.co.uk/doctor/Acute-Lymphoblastic-Leukaemia-(ALL).htm
  3. https://www.orpha.net/data/patho/Pro/en/AcuteLymphoblasticLeukemia-FRenPro3732.pdf
  4. http://gavilan.uis.edu.co/~laperez/docencia/asignatura3/pdfs/LLA_Review.pdf
  5. http://asheducationbook.hematologylibrary.org/content/2006/1/128.full.pdf
  6. http://www.med.upenn.edu/timm/documents/PuiLookLancetLeukemiareview.pdf

Further Reading

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