The prognosis in adults with ALL can be predicted from clinical and laboratory findings, especially the patient's age. Remission duration is an important determinant of long term survival.
Prognostic Factors Indicating Short Remission Duration:
(1) late achievement of complete remission (more than 4-5 weeks of therapy)
(2) high WBC count at presentation
(2a) critical value for worse prognosis currently is 25,000-35,000 per µL
(2b) counts > 100,000 per µL are associated with poor prognosis
(3) age > 50 years
(4) cell markers
(4a) possibly ALL with myeloid antigens (mixed lineage or hybrid)
(4a) possibly pre-T-ALL
(5) chromosomal abnormalities
(5a) Ph-ALL: t (9;22)
(5b) t (4;11)
Additional factors reportedly affecting prognosis:
(1) organ involvement at presentation (extensive lymphadenopathy, hepatomegaly, splenomegaly, central nervous system involvement, mediastinal involvement)
(2) male gender
(3) elevated LDH
(4) elevated GGT levels
(5) low platelet count
(6) degree of bone marrow involvement
(7) number of immature forms in the peripheral blood
(8) weight loss
(9) race
The impact of some negative prognostic factors in the past has changed to the better with advances in treatment regimens.
