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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.
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