Prognosis for the child with ALL

Treatment of childhood ALL is one of the major success stories of modern medicine. In the early 1960s, patients with ALL usually lived only for a few months. In 2001, 75 percent of children receiving optimal treatment were cured. The appropriate treatment for each child with ALL is determined by analysis of a multitude of features related to the child and to the leukemia cells. Children who have high-risk disease need more aggressive treatments than do children with average-risk disease. The following are some of the factors that doctors consider when determining treatment.

Children ages 1 to 9 typically do better than do infants or older children or teens. Infants with parts of the MLL gene (at chromosome segment 11q23) rearranged have a higher risk of relapse than do other infants. More aggressive treatments are usually needed for infants and children or teens over the age of 9.

White blood count at diagnosis

Children with a WBC count lower than 50,000 per cubic milliliter have a better prognosis than those with a higher white blood cell count. Most institutions place children with high white blood counts on more intensive protocols (written plans for treating disease).

Leukemia cell type

There are two lines of leukemia cells in ALL: B cells and T cells. Some common antigens (proteins on the surface of the cells) found on B leukemia cells are called CD19, HLA-DR, and CD10 (cALLa). Eighty to 85 percent of children with ALL have B-lineage ALL with one or more of these antigens. B-lineage ALL has three levels of cell maturity that help the doctors decide on the best treatment.

• Early pre-B. About three quarters of children with B-lineage ALL have early pre-B. This has the best prognosis of all types of ALL.

• Pre-B. Approximately 25 percent of children with pre-B ALL have the t(1;19) chromosome abnormality (translocation). Although this used to be a poor prognostic factor, with more aggressive modern treatments children with pre-B ALL appear to fare as well as those with early pre-B leukemia.

• B cell. Approximately 2 percent of children with B-lineage ALL have B cell ALL. This is the leukemic stage of Burkitts lymphoma, and it has a completely different treatment than other types of ALL.

Approximately 15 percent of children with ALL have T-cell ALL. T-cell ALL has one or more of the following antigens on the surface of the cancer cells: CD2, CD7, CD5, CD8, or CD3. Often, children with T-cell ALL are male, have high WBC counts, have masses in their chests at diagnosis, and are over 10 years old. T-cell ALL requires more intensive therapy, but outcomes after intensive therapy are similar to those for B-lineage ALL.

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