Patient selection: acute lymphoblastic leukemia (ALL) following induction therapy (therapy intended to induce a remission)
Factors associated with a poor prognosis in a patient with induction failure:
(1) age >= 10 years
(2) T-cell phenotype
(3) 11q23 rearrangement
(4) >= 25% blasts in the bone marrow (M3)
Additional high risk factors:
(1) male gender
(2) high leukocyte count
(3) central nervous system involvement
(4) t(9;22)BCR-ABL1 (Philadelphia chromosome)
Favorable findings for a patient with precursor B-cell leukemia:
(1) age at diagnosis 1 to 5 years
(2) high hyperdiploidy (modal chromosome number > 50)
(3) no unfavorable genetic factors
A patient with precursor B-cell leukemia and favorable findings had a better outcome with chemotherapy only.
A patient with a T-cell leukemia had a better outcome with an allogenetic stem-cell transplant (STEM) from a matched, related donor.
