Cancer Information

Clinical features- Acute Lymphocytic Leukemia

Anemia - feeling tired, short of breath and looking pale, caused by too few red blood cells

Bruising easily and having cuts that heal slowly or not at all, caused by too few platelets

Having frequent infections, especially of the skin or ear, caused by too few normal white blood cells

Prognostic indicators for ALL

1. Age at Diagnosis - Age at diagnosis has strong prognostic significance, reflecting the different underlying biology of ALL in different age groups. Infants with ALL have a particularly high risk of treatment failure, with the risk of treatment failure being greatest for young infants (younger than 3 months) and those with poor early-response to prednisone. Rearrangement of the MLL gene at chromosome band 11q23 can be detected in the leukemia cells of a large percentage of infants with ALL, and the poor outcome for infants with ALL is strongly associated with the presence of the MLL gene rearrangement.

2.WBC Count at Diagnosis - Higher WBC counts at diagnosis represent an increased risk for treatment failure in patients with B-precursor ALL. A WBC count of 50,000/dl is generally used as an operational cut point between better and poorer prognosis. Elevated WBC count is often associated with other high-risk prognostic factors, including unfavorable chromosomal translocations such as t(4;11) and t(9;22)

3. CNS Status at Diagnosis - CNS status at diagnosis has prognostic significance. Patients who have a non-traumatic diagnostic lumbar puncture may be placed into 3 categories according to their CNS status:

CNS1: CSF <5 WBC/dl with cytospin negative for blasts.

CNS2: CSF <5 WBC/dl with cytospin positive for blasts.

CNS3: CSF ≥5 WBC/dl with cytospin positive for blasts.

Children with ALL who present with CNS disease at diagnosis (i.e., CNS3) are at higher risk for treatment failure (both within the CNS and systemically) compared to patients not meeting the criteria for CNS disease at diagnosis. While CNS2 cases may be at increased risk of CNS relapse.

4. Gender -The prognosis for girls with ALL is slightly better than for boys with ALL.

5. Race - Survival rates for black and Hispanic children with ALL are somewhat lower than those for white children with ALL. Asian children with ALL fare slightly better than white children.