prognosis of ALL

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The following factors are associated with prognosis in ALL patients:

  • age at diagnosis is considered to be a strong prognostic factor. According to a study carried out at children’s Research Hospital with 847 children with ALL:
    • children between the age 1 to 9 had a better outcome than infants or adolescents. The 5 year event free survival estimates were (1)
      • for children aged 1-9 - 88%
      • adolescents aged 10–15 years - 73%
      • older than 15 years - 69%
      • babies younger than 12 months - 44%
    • prognosis was poor especially for babies younger than 6 months

    • age-specific mortality rates rise steadily from birth and more steeply from around age 45-49. The highest rates are in the 85 to 89 age group for males and the 90+ age group for females (2)


  • increased leukocyte count presents with poor prognostic outcome.
    • this is especially true in patients with B-cell precursor disease
    • in T cell ALL, a count of more than 100x109/L is associated with an increased risk of relapse in the CNS
    • high risk of early complications are seen in patients with extreme hyperleucocytosis (>400x109/L) e.g - CNS haemorrhage and pulmonary and neurological events due to leucostasis (1)
  • chromosomal   abnormality
    • poorer outcome is also associated with Philadelphia chromosome, t(4;11) with MLL-AF4 fusion, and hypodiploidy (<44 chromosomes per leukaemic cell)
    • favourable prognosis was seen in patients with hyperdiploidy (>50 chromosomes), TEL-AML1fusion, and trisomy 4, 10, and 17

Children respond well to treatment:

  • 95% achieve complete remission
  • 50-60% of whom are cured with postremission chemotherapy

Fewer advances have been achieved in adults:

  • 80% achieve complete remission
  • about 35% achieve long-term disease-free survival

The poorer response seen in adults may reflect undertreatment because of the increased risk of drug toxicity.

Reference:

Last edited 05/2019 and last reviewed 05/2019

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