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Prognosis

A prognosis is a description of the overall outlook or forecast of your disease. It may include positive or negative predictions about things like symptoms, recovery, and treatment needs. Your acute lymphoblastic leukemia prognosis is influenced by a number of factors, but even knowing these cannot tell you the exact course of the disease. Certain factors may indicate whether you require more aggressive treatment.

Age

Age has an important influence on how the disease will progress and how you or your child will respond to treatment. In general, younger people have a better outlook.

Cure rates are better for children aged 1−9 years who have B-cell acute lymphoblastic leukemia. Children younger than 1 or older than 9 are considered to have a higher risk of seeing the disease return after treatment. This does not mean they cannot be cured, but that their prognosis is not as good as those patients who are 1–9 years old. Age does not appear to influence the outlook of patients with pre-T-cell acute lymphoblastic leukemia to the same extent – it is a less important factor in this disease subtype.1

For teenagers and young adults between 15 and 24 years old with acute lymphoblastic leukemia, the prognosis remains fairly good, with 70% of patients being alive after 5 or more years from their diagnosis.2

For adults aged 25–64, the chance of survival after 5 years is close to 40%. In people 65 and older, around 15% will survive 5 years or more following their diagnosis.2

Initial white blood cell count

A high number of white blood cells at the time of diagnosis can indicate greater risk of a more difficult-to-treat disease. In these cases, patients often receive intensive treatment.

Acute lymphoblastic leukemia subtype

Precursor B-cell acute lymphoblastic leukemia tends to carry a more favorable prognosis than mature B-cell (sometimes called Burkitt) leukemia. Pre-T-cell acute lymphoblastic leukemia has a similar favorable outlook to pre-B-cell acute lymphoblastic leukemia.1

Genetic factors

Number of chromosomes within the cell

Chromosomes are structures found in our cells that carry genetic information (our DNA). Under normal circumstances, a human cell has 46 chromosomes. In leukemic cells, sometimes chromosomes can be duplicated or deleted, so the total number may be different to the usual 46. When a cell has less than 44 chromosomes, it is called hypodiploid. Cells with greater than 50 chromosomes are known as hyperdiploid cells.

Patients with hypodiploid acute lymphoblastic leukemia tend to have a less favorable prognosis than patients with hyperdiploid acute lymphoblastic leukemia.

Chromosome changes

In leukemic cells, your genetic material can undergo changes, including swapping of parts between chromosomes. This is known as translocation. Patients that have a translocation between chromosomes 12 and 21 have a more favorable outlook.1

Other translocations indicate a poorer prognosis, including the Philadelphia chromosome translocation, which is caused by swapping of genetic material between chromosomes 9 and 22.1

Response to treatment

Prognosis is also affected by how your leukemia responds to initial treatment. Patients that achieve remission (when there is no sign of leukemic cells on your bone marrow tests) after initial treatment have a better overall disease outlook.

References

1. American Cancer Society. Prognostic factors in childhood leukemia (ALL or AML). https://www.cancer.org/cancer/leukemia-in-children/detection-diagnosis-staging/prognostic-factors.html. Published Feb 12, 2019. Accessed Mar 31, 2021.

2. Cancer Research UK. Survival. https://www.cancerresearchuk.org/about-cancer/acute-lymphoblastic-leukaemia-all/survival. Published Apr 17, 2018. Accessed Mar 31, 2021.

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What is acute lymphoblastic leukemia?Causes & symptomsDiagnosisTypesTreatmentPrognosisRemissionRelapse

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