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29

NCCN Guidelines for Patients

®

:

Acute Lymphoblastic Leukemia, Version 1.2017

3

Treatment planning

Prognostic factors | Review

Prognostic factors

Several important factors affect treatment options

and the likely outcome (prognosis) of ALL.

Something that affects and helps predict prognosis is

called a prognostic factor.

Doctors use certain prognostic factors to help

predict how ALL will likely progress and respond to

treatment. This helps doctors plan how intensive

treatment needs to be for each patient to kill all the

leukemia cells and keep them from coming back.

These factors can also help doctors decide which

type of treatment will likely work best.

Some prognostic factors are linked with a lower

chance (risk) that ALL will come back after treatment.

These are called “good risk” features. Other factors

are linked with a higher risk that ALL will come back

after treatment. These are called “poor risk” features.

Doctors give more intensive treatments for ALL that

has poor risk features. But, the presence of poor risk

features does not mean ALL can’t be cured.

A number of factors can affect prognosis in ALL.

Some are more important for treatment planning

than others. The two main factors doctors use to plan

treatment are your age and the cytogenetic subtype.

But, other prognostic factors for ALL that may also be

helpful include:

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Age:

The leukemia cells in older patients tend

to be more resistant to treatment. Stronger

treatments may be needed to kill all the

leukemia cells and keep them from coming

back.

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Philadelphia chromosome:

Leukemia cells

that have the Philadelphia chromosome can

be harder to treat. But, new treatments have

improved outcomes in the past few years.

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Chromosome changes:

Certain changes in

chromosomes can make leukemia cells harder

to treat. This includes having fewer than the

normal number of chromosomes and having

five or more chromosome changes in the

leukemia cells.

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White blood cell count:

The number of white

blood cells in the blood at the time ALL is

diagnosed can also affect prognosis. Having a

very high white blood cell count at diagnosis is

a poor risk feature in children and adolescents

with ALL. This factor has a much smaller effect

on treatment planning for adults with ALL.

Review

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A number of factors help guide treatment

options and the likely outcome (prognosis).

†

†

Something that affects and helps predict the

likely outcome is called a prognostic factor.

†

†

Age is one of the most important factors that

affect treatment options.

†

†

To help plan treatment, ALL is classified into

smaller groups called subtypes based on

certain features of the leukemia cells.

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ALL is classified into groups based on the

type of cell—called the cell subtype. It is also

classified into smaller groups based on the type

of chromosome changes in the leukemia cells.

These are called cytogenetic subtypes.