Schrappe et al listed criteria for failure of induction therapy for a patient with acute lymphoblastic leukemia (ALL). Induction failure may be associated with a worse prognosis for the patient. The authors are from multiple institutions in North America and Europe.


Patient selection: acute lymphoblastic leukemia (ALL) following induction therapy (therapy intended to induce a remission)


Morphologic criteria for induction failure - one or both of the followng:

(1) >= 5% blasts in the bone marrow at the end of induction therapy

(1a) M3 (>= 25% blasts)

(1b) M2 (5 to 24.9% blasts)

(2) blasts present at an extramedullary site at the end of the induction therapy


A remission after induction therapy involves both of the following:

(1) < 5% blasts in the bone marrow (M1)

(2) no blasts at any extramedullary sites


With remission there should be no blasts in the peripheral blood.


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