Prognosis

Updated March 27, 2026

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 year or older than 9 years 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.

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.

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.

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 leukemia (sometimes called Burkitt leukemia) and, in children and young adults, T-cell acute lymphoblastic leukemia. Although historically less favorable, with appropriate intensive modern therapy, children with T-cell acute lymphoblastic leukemia now have a prognosis approaching that of children with B-cell acute lymphoblastic leukemia. In adults, outcomes with T-cell acute lymphoblastic leukemia have also improved and are comparable to precursor B-cell acute lymphoblastic leukemia.

Genetic factors

Genetic subtype is a major prognostic factor in acute lymphoblastic leukemia. ETV6::RUNX1 and high hyperdiploid acute lymphoblastic leukemia are both associated with a good response to initial therapy and a favorable long-term outcome. In contrast, KMT2A, hypodiploidy, iAMP21 and TCF3::HLF acute lymphoblastic leukemia are considered high-risk subtypes with a higher risk of relapse. BCR::ABL1 and ABL-class fusion acute lymphoblastic leukemia have historically been classified as high-risk; however, targeted therapies have improved outcomes, although prognosis also influenced by patient age. The prognostic impact of other genetic subtypes is currently under investigation. 

Response to treatment

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