Schrappe et al listed risk factors for failure of induction therapy for a patient with acute lymphoblastic leukemia (ALL). A patient who fails induction therapy may require more aggressive management. 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)


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.


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