As with AML, an accurate assessment of prognosis is important for the treatment and management of ALL. Both clinical factors and cytogenetic changes impact prognosis and treatment.
The two most important clinical factors are age and white blood count. The younger the age and the lower the white blood count at the time of initial diagnosis, the better the prognosis. Even including cases with less favorable cytogenetic profiles, the prognosis for children of disease-free survival for five years is >80%. Someone with disease-free survival for five years is considered to be cured.
Among cytogenetic findings, hyperdiploidy (~51-65 chromosomes) and the absence of Philadelphia Chromosome are associated with a good prognosis.
The bullets below summarizes some of the clinical and genetic prognostic factors.
Favorable prognostic factors- Age 3-9 years
- WBC count <25,000/ μL in adults or <50,000 in children
- Hyperdiploidy (51-65 chromosomes)
- T(1/19) and t(12/21)
- No CNS involvement at diagnosis
Unfavorable prognositc factors
- Karyotype with hypodiploidy (<46 chromosomes) at diagnosis
- Very high hyperdiploidy - 66-88 chromosomes at diagnosis
- Presence of Philadelphia Chromosome BCR-ABL1
- Other specific translocations associated with an unfavorable outcome
- Increased age in adults
- More frequent and severe comorbidities
