All of the following are good prognostic factors for childhood. ALL except:
High-Yield Explanation
Answer is C (Pre B cell ALL) Hyperdiploidy, Female sex and translocation t (12, 21) are associated with good prognosis. Pre B cell ALL may be associated with a poor prognosis and is the single answer of exclusion. Hyperdiploidy Female sex and translocation t (12, 21) are associated with good prognosis. Prognostic factor for ALL: Determinants Favourable Unrourable White blood cell count Low WBC count* High WBC count* Age 3-7 yrs <1,> 10 yr Gender Female Male Ethnicity White Black Node, Liver, spleen enlargement Absent Massive Testicular enlargement Absent Present Central nervous system leukemia Absent Ove (blasts + pleocytosis) FAB morphological features L 1 L2 Ploidy Hyperdiploidy Hypodiploidy < 45 DNA index > 0.16 < 0.16 Cytogenenetic markers Trisomies 4, 10 and/or 17 t(12;21) (tel aml 1) t(9; 22) t(4; 11) t(1; 19) Time to remission < 14 d > 28 d Minimal residual disease < 104 > 10-3 Immunophenotype Early Pre-B cell T cell Pre B cell ALL is often associated with an unourable prognosis (although it may be associated with a ourable outcome) Pre B cell ALL has been associated with a poorer outcome compared to Early Pre B cell ALL. - Wintrobe's Immunophenotype and Prognosis Early Pre B cell ALL Pre B cell ALL Mature B cell ALL T cell ALL Early Pre B cell All Pre B cell ALL account for Mature B cell ALL in T cell ALL accounts for comprises about 2/3 20% of childhood ALL uncommon in children and 15% of ALL in children cases of childhood ALL and have been associated accounts for 1-2% of T cell ALL was and is associated with a with a poorer outcome childhood ALL. (previously) associated ourable prognosis. compared to Early Pre B It is characterized by L3 with a poor prognosis but Most Early Pre B cell cell ALL. FAB morphology and has recent use of more ALL are CALLA positive. CALLA expression does not appear to have independent prognosis significance. a poor prognosis. intensive therapeutic regimen has resulted in survival approaching that of Non T cell ALL.