Identification of significant risk factors in a patient helps in selecting the optimum treatment protocol for that patient, permitting a more or less aggressive approach as needed.
Parameters:
(1) age
(2) initial white blood cell count
(3) sex
(4) race
(5) cytogenetics
(6) immunophenotype
(7) FAB morphology
(8) organomegaly
(9) mediastinal mass
(10) lymphadenopathy
(11) hemoglobin
(12) LDL
(13) platelet count
(14) serum immunoglobulins
(15) rapidity of leukemic cytoreduction on induction therapy
(16) response to initial course of induction chemotherapy
|
Parameter |
Finding |
Prognosis |
|---|---|---|
|
age |
< 12 months |
very poor |
|
|
12-23 months |
poor (?) |
|
|
2 - 10 years |
good |
|
|
> 10 years |
poor |
|
initial white blood cell count |
> 200,000 per µL |
very poor |
|
|
> 50,000 per µL |
poor |
|
|
< 10,000 |
good |
|
sex |
females |
good |
|
|
males |
poor |
|
race |
Blacks |
poor |
|
cytogenetics |
hyperdiploidy (> 50 chromosomes) |
good |
|
|
hypoploidy |
poor |
|
|
t (8;14) |
very poor (induction failure and early relapse) |
|
|
t (9;22) (Philadelphia chromosome) |
very poor (induction failure and early relapse) |
|
|
t (4;11) |
poor (induction failure and early relapse) |
|
|
dicentric translocation involving short arms of 9 and 12 |
good |
|
|
t (1;19) and pre-B immunophenotype (not early pre-B) |
poor |
|
|
MLL gene rearrangement in infants |
very poor |
|
immunophenotype |
early pre-B cell (no cytoplasmic immunoglobulin) |
good |
|
|
pre-B cell (cytoplasmic immunoglobulin) |
poor |
|
|
mature B cell |
very poor |
|
|
T cell |
poor |
|
|
myeloid markers present |
poor |
|
FAB morphology |
L3 |
poor |
|
|
L2 |
poor |
|
|
L1 |
good |
|
mediastinal mass |
present |
poor |
|
organomegaly |
hepatomegaly |
poor |
|
|
splenomegaly |
poor |
|
lymphadenopathy |
present |
poor |
|
hemoglobin level |
|
|
|
LDH |
|
|
|
platelet count |
|
|
|
serum immunoglobulins |
low IgM |
poor |
|
|
low IgG and/or IgA |
poor |
|
rapidity of leukemic cytoreduction on induction therapy |
residual leukemia on day 14 of induction therapy |
poor |
|
response to initial course of induction chemotherapy |
failure to achieve complete remission |
poor |
where:
• The relationship between initial WBC count and prognosis is linear and continuous, with the prognosis inversely related to the count.
• The worse prognosis in males is related to testicular relapse and the higher rate of T cell ALL.
• The worse prognosis in Blacks is associated with an increased frequency of very high initial white blood cell counts, mediastinal mass, and L2 morphology.
• Mediastinal mass, hepatomegaly, splenomegaly and lymphadenopathy reflect high initial tumor burden and correlation with the initial WBC count.
• > 1,000 blasts per µL one week after preliminary treatment with glucocorticoids and intrathecal methotrexate is a poor prognostic finding (Arico et al)
Specialty: Hematology Oncology
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