NCCN Guidelines for Patients
Acute Lymphoblastic Leukemia, Version 1.2017
Prognostic factors | Review
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
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
that have the Philadelphia chromosome can
be harder to treat. But, new treatments have
improved outcomes in the past few years.
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
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.
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.
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.