Materiały źródłowe

• #1 Acute lymphoblastic leukemia: a comprehensive review and 2017 update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5520400/

  Acute lymphoblastic leukemia (ALL) is the second most common acute leukemia in adults, with an incidence of over 6500 cases per year in the United States alone. […] Despite advances in management, the backbone of therapy remains multi-agent chemotherapy with vincristine, corticosteroids and an anthracycline with allogeneic stem cell transplantation for eligible candidates. Elderly patients are often unable to tolerate such regimens and carry a particularly poor prognosis. […] Prognosis for the elderly remains very poor. Despite a high rate of response to induction chemotherapy, only 30-40% of adult patients with ALL will achieve long-term remission. […] Accurate assessment of prognosis is central to the management of ALL. Risk stratification allows the physician to determine the most appropriate initial treatment regimen as well as when to consider allogeneic stem cell transplantation (Allo-SCT).

• #1 Acute Lymphocytic Leukemia (ALL) Subtypes and Prognostic Factors | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/detection-diagnosis-staging/how-classified.html

  For most types of cancer, determining the stage (extent) of the cancer is very important. The outlook for a person with ALL depends on other information, such as the subtype of ALL (determined by lab tests), the patient’s age, and other lab test results. […] Doctors have found that cytogenetic tests, flow cytometry, and other lab tests provide more detailed information about the subtype of ALL and the patients prognosis. […] As leukemia treatment has improved over the years, research has focused on why some people have a better chance for cure than others. Different factors that affect a person’s prognosis (outlook) are called prognostic factors. They can help doctors decide if people with a certain type of leukemia should get more or less treatment. […] Among adults, younger patients tend to have a better prognosis than older patients.

• #1 Acute lymphoblastic leukemia: A population-based study of outcome in the United States based on the surveillance, epidemiology, and end results (SEER) database, 1980–2017

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9517941/

  The overall 5-year survival rates have improved significantly over time, from 51% before 1990 to 72% since 2010. […] The survival rates for children (age 0 to 14 years) and adolescents (age 15 to 19 years) have improved from 73% and 55% before 1990 to 93% and 74% since 2010, respectively. […] Similarly, the rates had improved from 33% to 59% for adults 20 to 29 years old, 24% to 59% for 30 to 39 years old, and 14% to 43% for 40 to 59 years old between the two time periods. […] Since 2010, patients with Ph-negative ALL had 5-year survival rate of 73% and those with Ph-positive ALL 50%. […] The outcome of patients with ALL showed continued improvement across all age groups in the US. […] The recent introduction of targeted therapies, together with optimized supportive care, will continue to improve outcomes, particularly in older patients.

• #1 Acute lymphoblastic leukemia: a comprehensive review and 2017 update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5520400/

  Increasing age portends a worsening prognosis. Patients over the age of 60 have particularly poor outcomes, with only 10-15% long-term survival. […] The cytogenetic aberration with the greatest impact on prognosis and treatment is the presence of the Philadelphia chromosome, t(9;22). […] Ph-positivity has implications both in terms of prognosis and for treatment. Historically, Ph-positive ALL has a 1-year survival of around 10%. However, with the development of TKIs, survival has improved and thus the Ph-status of all patients must be obtained prior to starting therapy. […] More recently, a subset of high-risk ALL without t(9;22) has been identified with a genetic profile similar to that of Ph-positive ALL. This so called, Ph-like ALL has been associated with poor response to induction chemotherapy, elevated minimal residual disease and poor survival.

• #1 Prognostic Factors in Childhood Leukemia (ALL or AML) | American Cancer Society

  https://www.cancer.org/cancer/types/leukemia-in-children/detection-diagnosis-staging/prognostic-factors.html

  Children with ALL who have very high WBC counts (greater than 50,000 cells per cubic millimeter) when they are diagnosed are at higher risk and need more intensive treatment. […] Children with early B-cell ALL subtypes generally do better than those with mature B-cell (Burkitt) leukemia. The outlook for T-cell ALL seems to be about the same as that for B-cell ALL as long as treatment is intense enough. […] Girls with ALL may have a slightly higher chance of being cured than boys, but as treatments have improved in recent years, this difference has shrunk. […] Children are more likely to be cured if their leukemia cells have more than 50 chromosomes (called hyperdiploidy), especially if there is an extra chromosome 4, 10, or 17. Hyperdiploidy can also be expressed as a DNA index of more than 1.16. Children whose leukemia cells have fewer than 44 chromosomes (known as hypodiploidy) have a less favorable outlook.

• #1 Acute lymphoblastic leukemia: A population-based study of outcome in the United States based on the surveillance, epidemiology, and end results (SEER) database, 1980–2017

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9517941/

  The estimated 5-year survival rate improved from 51% before 1990 to 72% since 2010. […] The estimated survival rates for children (age 0 to 14 years) and adolescents (15 to 19 years) had improved from 73% and 55% before 1990 to 93% and 74% since 2010, respectively. […] The rates had also improved from 33% to 59% for adults 20 to 29 years old, 24% to 59% for adults 30 to 39 years old, and 14% to 43% for those aged 60+ years between the same time periods. […] The estimated 5-year survival rate in adult ALL of 50% in Ph-positive disease reflects the addition of first and second-generation TKIs. […] The estimated survival of 73% in Ph-negative ALL could soon be significantly improved with the addition of CD20, CD19, and CD22 antibodies to the chemotherapy in adult (age 30-46 years) and older ALL (age 60+ years). […] The multivariate analysis for survival confirmed that the early time period, older age at diagnosis, Hispanic or Black ethnicity, lower median annual income, lower population density, and male gender were independent adverse prognostic factors for survival.

• #1 Acute Lymphocytic Leukemia (ALL) Subtypes and Prognostic Factors | American Cancer Society

  https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/detection-diagnosis-staging/how-classified.html

  People with a lower WBC count (less than 30,000 for B-cell ALL and less than 100,000 for T-cell ALL) when they are first diagnosed tend to have a better prognosis. […] Whether the leukemia cells have certain changes in their genes or chromosomes can affect prognosis. […] Patients who go into a complete remission (no visible leukemia in the bone marrow see below) within 4 to 5 weeks of starting treatment tend to have a better prognosis than those for whom this takes longer. […] How well leukemia responds to treatment affects the patients long-term chance for recovery. […] A complete molecular remission means there is no evidence of leukemia cells in the bone marrow, even when using very sensitive lab tests, such as polymerase chain reaction (PCR). […] Patients with MRD after treatment are more likely to have the leukemia relapse (come back after treatment) and overall have a poorer outlook than those who achieve a complete remission. […] Active disease means that either there is evidence that the leukemia is still present during treatment or that the disease has relapsed (come back) after treatment.

• #1 Prognosis and survival for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/prognosis-and-survival

  The response to chemotherapy is measured as the time it takes to reach a complete remission, or complete response. When a complete remission is reached within 4 weeks of starting chemotherapy, the prognosis is more favourable. The prognosis is less favourable when it takes longer to reach complete remission. The prognosis is poorer in people who dont reach a complete remission after chemotherapy. […] An early relapse means that the leukemia returns soon after treatment. It is a poor prognostic factor. […] Spread of ALL to the brain and spinal cord (called the central nervous system, or CNS) is a poor prognostic factor. […] People with ALL are divided into the following prognostic risk groups: Good risk means that the person with ALL has a more favourable prognosis. […] Poor risk means that the person with ALL has a less favourable prognosis. People in the poor risk group: have unfavourable chromosome abnormalities t(9;22), t(4;11), are older than 60 years of age, have ALL with a WBC count greater than 100,000, do not reach a complete remission within 4 weeks.

• #1 Acute lymphoblastic leukemia – Wikipedia

  https://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia

  Cytogenetics, the study of characteristic large changes in the chromosomes of cancer cells, is an important predictor of outcome. Some cytogenetic subtypes have a worse prognosis than others. These include: Person with t(9,22) positive-ALL (30% of adult ALL cases) and other Bcr-abl-rearranged leukemias are more likely to have a poor prognosis, but survival rates may rise with treatment consisting of chemotherapy and Bcr-abl tyrosine kinase inhibitors. A translocation between chromosomes 4 and 11 occurs in about 4% of cases and is most common in infants under 12 months. […] Hyperdiploidy (50 chromosomes) and t(12;21) are good prognostic factors and also makeup 50% of pediatric ALL cases.

• #1 Prognostic Factors in Childhood Leukemia (ALL or AML) | American Cancer Society

  https://www.cancer.org/cancer/types/leukemia-in-children/detection-diagnosis-staging/prognostic-factors.html

  Children whose leukemia cells have a translocation between chromosomes 12 and 21 are more likely to be cured. Those with a translocation between chromosomes 9 and 22 (the Philadelphia chromosome) or 4 and 11 tend to have a less favorable prognosis. Some of these poor prognostic factors have become less important in recent years as treatment has improved. […] Children whose leukemia goes into remission (major reduction of cancer cells in the bone marrow) within 1 to 2 weeks of chemotherapy have a better outlook than those whose leukemia does not. […] Prognostic factors are not quite as important in predicting outcome or in guiding treatment for AML as they are for ALL. […] Children with AML whose WBC count is less than 100,000 cells per cubic millimeter at diagnosis tend to do better than those with higher counts.

• #1 Prediction of outcomes by early treatment responses in childhood T-cell acute lymphoblastic leukemia: a retrospective study in China | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-015-0390-z

  Early treatment responses are important prognostic factors in childhood T-cell acute lymphoblastic leukemia (T-ALL) patients. The predictive values of early treatment responses in Chinese childhood T-ALL patients were still unknown. […] The 5-year event free survival (EFS) and overall survival (OS) rates for these patients were 62.5 % (SE, 6.4) and 62.7 % (SE, 6.6), respectively. […] Prednisone poor responder was strongly associated with increased chance of induction failure (14.8 %) and decreased survival rate (5 year EFS rate, 51.1 % (SE, 10.5)). […] Patients with 25 % blast cells in bone marrow at day 15 were more likely to have an inferior outcome. […] MRD 102 at TP1 or MRD 103 at TP2 was significantly related to dismal prognosis. […] Risk groups classified by MRD at two time points could stratify patients into different groups: 29.0 % of the patients were MRD standard risk (MRD104 at both time points) with 3-year EFS rate of 100 %, 29.0 % were MRD high risk (MRD 102 at TP1 or MRD 102 at TP2) with 3-year EFS rate of 55.6 % (SE, 16.6), and the rest of patients were defined as MRD intermediate risk with 3-year EFS rate of 85.7 % (SE, 13.2).

• #1 Acute lymphoblastic leukemia: a comprehensive review and 2017 update | Blood Cancer Journal

  https://www.nature.com/articles/bcj201753

  Poor MRD clearance, defined as levels 1 x 10^3 after induction and levels 5 x 10^4 after early consolidation by flow cytometry, was the only significant prognostic factor for disease-free and overall survival. […] Allo-SCT has long been considered the standard of care and best chance for a durable response. […] It is therefore recommended that all high-risk young adults with an available donor undergo Allo-SCT during their first CR (CR1). […] The role of Allo-SCT in standard-risk adults is less clearly defined. […] In patients with positive MRD, Allo-SCT was associated with improved relapse-free survival. However, in patients with a complete MRD response, there was no survival benefit to Allo-SCT over standard chemotherapy. […] The successes from tyrosine kinase inhibition in CML have been translated to Ph-positive ALL, and second and third generation TKIs are being studied for use in high-risk Ph-like disease. […] As the role of these novel agents is further defined and integrated into new treatment strategies, adult ALL may follow pediatric ALL as a major success story in the near future.

• #1 Acute lymphoblastic leukemia: a comprehensive review and 2017 update

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5520400/

  Studies found that MRD-positivity is an independent risk factor for decreased relapse-free and overall survival. […] Allo-SCT also should be considered in all patients that relapse, optimally after achieving a second CR (CR2). […] Acute lymphoblastic leukemia has been touted as a major success story in pediatric oncology through the implementation of dose-intensification chemotherapy and Allo-SCT. However, due to high-risk disease characteristics and significant toxicity associated with chemotherapy in adults, outcomes are far less encouraging. […] The successes from tyrosine kinase inhibition in CML have been translated to Ph-positive ALL, and second and third generation TKIs are being studied for use in high-risk Ph-like disease.

• #1 Prognostic Factors in Childhood Leukemia (ALL or AML) | American Cancer Society

  https://www.cancer.org/cancer/types/leukemia-in-children/detection-diagnosis-staging/prognostic-factors.html

  In children with acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML), certain factors that can affect a child’s outlook (prognosis) are called prognostic factors. They help doctors decide how intense treatment needs to be. Prognostic factors seem to be more important in ALL than in AML. […] Children with ALL are often put into risk groups (such as low risk, standard risk, high risk, or very high risk), with more intensive treatment given to higher risk patients. Generally, children at low risk have a better outlook than those at very high risk. But it’s important to know that even children in higher risk groups can often still be cured. […] Children between the ages of 1 and 9 with B-cell ALL tend to have better cure rates. Children younger than 1 year and children 10 years or older are considered high-risk patients. The outlook in T-cell ALL isn’t affected much by age.

• #1 Acute Lymphoblastic Leukemia: Symptoms, Treatment & Prognosis

  https://www.cancercenter.com/cancer-types/leukemia/types/acute-lymphocytic-leukemia

  Acute lymphoblastic leukemia (ALL), also called acute lymphocytic leukemia or acute lymphoid leukemia, is a blood cancer that results when abnormal white blood cells (leukemia cells) derived from lymphoid precursors (partially differentiated cells) accumulate in the bone marrow. […] The National Cancer Institute SEER Program reports that the five-year relative survival rate for patients with ALL is 71.3 percent. […] This means that 71.3 percent of people with acute lymphoblastic leukemia are alive five years or more after diagnosis, compared to people who dont have ALL.

• #1 Survival statistics for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/prognosis-and-survival/survival-statistics

  Survival statistics for acute lymphoblastic leukemia (ALL) are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for ALL is 51%. This means that about 51% of people diagnosed with ALL will survive for at least 5 years. […] People with ALL must be treated. Without treatment, survival is only a few months. […] With current treatment regimens, about 80%90% of people with ALL will reach a complete remission (which means that leukemia cells cannot be seen in the bone marrow). About half of these people relapse. […] About 40%50% of people with ALL reach a complete remission and do not relapse. These rates vary with the subtype of ALL and other prognostic factors.

• #1 Acute Lymphoblastic Leukemia (ALL): Symptoms, Treatment & Prognosis

  https://my.clevelandclinic.org/health/diseases/21564-acute-lymphocytic-leukemia

  Acute lymphocytic leukemia (ALL) is a cancer of the blood and bone marrow. It affects white blood cells, which your body needs to fight infection. Its the most common type of cancer in children, but can also affect adults. Children have a much better chance of recovering from ALL than adults. […] While ALL is a serious condition, thanks to newer treatments, including long-term chemotherapy, children with the condition can be cured, and other people are living longer with ALL. […] Your prognosis is the outcome you may expect after treatment. ALL often goes into complete remission after chemotherapy that kills cancerous cells. In general, children and young adults have a better prognosis than do people age 20 and older. […] In some cases, yes, ALL can be cured. Children with ALL who remain in complete remission after five years are considered cured. Thats because ALL rarely recurs (comes back) after five years. Older children and adults with ALL are less likely to be cured because treatment doesnt always put ALL into long-term remission. […] More than 90% of children between birth and age 14 were alive five years after diagnosis. More than 70% of children age 15 to 19 were alive five years after diagnosis. More than 30% of people age 20 and older were alive five years after diagnosis.

• #1 SciELO Brazil – Adult acute lymphoblastic leukemia Adult acute lymphoblastic leukemia

  https://www.scielo.br/j/rbhh/a/vf6ZN8dbgCP7ZptNmrCRN3g/?lang=en

  The diagnostic methods aimed at defining ALL subgroups with a different prognostic likelihood have substantially broadened in recent years. […] The new risk stratification algorithm of adult ALL is more complex and is based on earlier „conventional parameters”, such as clinical characteristics including age, white blood cell count, organ involvement (e.g. CNS, mediastinum, extramedullary involvement); immunophenotype; cytogenetic aberrations and molecular genetics; monitoring of MRD. […] Young adult patients between 15 and 20 years of age with ALL represent a unique epidemiologic group in that they may be treated by either adult or pediatric hematologists. […] Recent data suggest that the outcome of this subgroup of patients is markedly improved if they are treated on intensive pediatric ALL protocols rather than on less intensive adult ALL protocols. […] It is easy to foresee that the continuous refinement of technological tools, aimed at an ever more sophisticated characterization of ALL cells, will progressively lead to an ever greater use of targeted strategies in the management of patients of all ages suffering from ALL.

• #1 Refining risk prediction in pediatric acute lymphoblastic leukemia through DNA methylation profiling | Clinical Epigenetics | Full Text

  https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-024-01662-6

  Acute lymphoblastic leukemia (ALL) is the most prevalent cancer in children, and despite considerable progress in treatment outcomes, relapses still pose significant risks of mortality and long-term complications. […] The relapse risk predictor (RRP) was constructed based on 16 CpG sites, demonstrating c-indexes of 0.667 and 0.677 in the training and test sets, respectively. The mortality risk predictor (MRP), comprising 53 CpG sites, exhibited c-indexes of 0.751 and 0.754 in the training and test sets, respectively. […] The precision of the RRP and MRP models improved when incorporating traditional risk group data, underscoring the potential for synergistic integration of clinical prognostic factors. The MRP model also enabled the definition of a risk group with high rates of relapse and mortality. Our results demonstrate the potential of DNA methylation as a prognostic factor and a tool to refine risk stratification in pediatric ALL. This may lead to personalized treatment strategies based on epigenetic profiling.

• #1 SciELO Brazil – Adult acute lymphoblastic leukemia Adult acute lymphoblastic leukemia

  https://www.scielo.br/j/rbhh/a/vf6ZN8dbgCP7ZptNmrCRN3g/?lang=en

  This review focuses on the most recent advances in the diagnostic and prognostic work-up of adult acute lymphoblastic leukemia (ALL), and on their implications in the clinical management of the disease. […] The next few years will tell us if this biologically-guided approach, which is progressively individualizing the management of adult ALL patients, will ultimately impact on the prognosis of a disease that has stagnated over many decades. […] The presence of BCR-ABL and of MLL rearrangements represents a well-established unfavorable prognostic factor. […] A useful measure in risk assessment is the rate of clearance of leukemic cells from the bone marrow during the early phase of therapy. […] In adult ALL, prospective studies with MRD-based risk stratification are ongoing. […] However, in general the decrease of MRD occurs slower in adults than in children and few patients reach a negative MRD status.

• #1 Prognosis and survival for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/prognosis-and-survival

  People with acute lymphoblastic leukemia (ALL) may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a persons medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] A prognosis is the doctors best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.

• #2 Prognosis and survival for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/prognosis-and-survival

  People with acute lymphoblastic leukemia (ALL) may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a persons medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] A prognosis is the doctors best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.

• #2 Prognosis and survival for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/prognosis-and-survival

  Younger adults, usually those younger than 50 years of age, have a more favourable prognosis than older adults. […] The white blood cell (WBC) count at the time of diagnosis is a prognostic factor for ALL. People with a WBC less than 30,000/mm for B-cell ALL and less than 100,000/mm for T-cell ALL tend to have a more favourable prognosis. […] Hyperdiploid B-ALL has a more favourable prognosis than other types of ALL, but the outcome is continuously improving with the use of targeted therapy, maintenance therapy and stem cell transplantation. […] In the past, having leukemia cells with the Ph chromosome (referred to as Ph-positive ALL, or Ph+ ALL) used to mean a less favourable prognosis. Today targeted therapy drugs are used to treat Ph+ ALL, so the prognosis for this cancer is more favourable.

• #2 Acute lymphoblastic leukemia – Wikipedia

  https://en.wikipedia.org/wiki/Acute_lymphoblastic_leukemia

  Prognosis: Children: 90% five-year survival rate. Adults: 35% five-year survival. […] Before the development of chemotherapy regimens and hematopoietic stem cell transplants, children were surviving a median length of 3 months, largely due to either infection or bleeding. Since the advent of chemotherapy, the prognosis for childhood leukemia has improved greatly and children with ALL are estimated to have a 95% probability of achieving a successful remission after 4 weeks of initiating treatment. People in pediatric care with ALL in developed countries have a greater than 80% five-year survival rate. It is estimated that 60-80% of adults undergoing induction chemotherapy achieve complete remission after 4 weeks, and those over the age of 70 have a cure rate of 5%. […] However, there are differing prognoses for ALL among individuals depending on a variety of factors: Gender: Females tend to fare better than males. Ethnicity: Caucasians are more likely to develop acute leukemia than African-Americans, Asians, or Hispanics. However, they also tend to have a better prognosis than non-Caucasians. Age at diagnosis: children 1-10 years of age are most likely to develop ALL and to be cured of it. Cases in older people are more likely to result from chromosomal abnormalities (e.g., the Philadelphia chromosome) that make treatment more difficult and prognoses poorer. Older people are also likely to have co-morbid medical conditions that make it even more difficult to tolerate ALL treatment. White blood cell count at diagnosis of greater than 30,000 (B-ALL) or 100,000 (T-ALL) is associated with worse outcomes. Cancer spreading into the central nervous system (brain or spinal cord) has worse outcomes. Morphological, immunological, and genetic subtypes. Person’s response to initial treatment and longer length of time required (greater than 4 weeks) to reach complete remission. Early relapse of ALL. Minimal residual disease. Genetic disorders, such as Down syndrome, and other chromosomal abnormalities (aneuploidy and translocations).

• #2 Acute lymphoblastic leukemia: A population-based study of outcome in the United States based on the surveillance, epidemiology, and end results (SEER) database, 1980–2017

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9517941/

  The estimated 5-year survival rate improved from 51% before 1990 to 72% since 2010. […] The estimated survival rates for children (age 0 to 14 years) and adolescents (15 to 19 years) had improved from 73% and 55% before 1990 to 93% and 74% since 2010, respectively. […] The rates had also improved from 33% to 59% for adults 20 to 29 years old, 24% to 59% for adults 30 to 39 years old, and 14% to 43% for those aged 60+ years between the same time periods. […] The estimated 5-year survival rate in adult ALL of 50% in Ph-positive disease reflects the addition of first and second-generation TKIs. […] The estimated survival of 73% in Ph-negative ALL could soon be significantly improved with the addition of CD20, CD19, and CD22 antibodies to the chemotherapy in adult (age 30-46 years) and older ALL (age 60+ years). […] The multivariate analysis for survival confirmed that the early time period, older age at diagnosis, Hispanic or Black ethnicity, lower median annual income, lower population density, and male gender were independent adverse prognostic factors for survival.

• #2 Prognostic Factors in Childhood Leukemia (ALL or AML) | American Cancer Society

  https://www.cancer.org/cancer/types/leukemia-in-children/detection-diagnosis-staging/prognostic-factors.html

  Children whose leukemia cells have a translocation between chromosomes 12 and 21 are more likely to be cured. Those with a translocation between chromosomes 9 and 22 (the Philadelphia chromosome) or 4 and 11 tend to have a less favorable prognosis. Some of these poor prognostic factors have become less important in recent years as treatment has improved. […] Children whose leukemia goes into remission (major reduction of cancer cells in the bone marrow) within 1 to 2 weeks of chemotherapy have a better outlook than those whose leukemia does not. […] Prognostic factors are not quite as important in predicting outcome or in guiding treatment for AML as they are for ALL. […] Children with AML whose WBC count is less than 100,000 cells per cubic millimeter at diagnosis tend to do better than those with higher counts.

• #2 Acute Lymphocytic Leukemia

  https://www.cancernetwork.com/view/acute-lymphocytic-leukemia

  Several prognostic factors have been identified for children and adults with ALL, and risk categories have been defined to guide therapy. […] Age: Infants younger than age 1 and children older than age 10 have a worse prognosis than patients 1 to 9 years old. […] WBC Count: The WBC count at presentation is a highly significant prognostic variable. Patients with counts higher than 10,000/L have a worse prognosis. […] Cytogenetic Characteristics: Cytogenetic characteristics are probably the most important prognostic factor for ALL. […] Hyperdiploidy is present in 25% to 30% of children with ALL but in only 10% to 20% of adults. […] Patients with high-risk features should be treated as good risks if hyperdiploid. […] The outcome of patients with Ph-positive ALL is poor, with significantly low complete remission rates and long-term disease-free survival rates.

• #2 Acute lymphoblastic leukemia: a comprehensive review and 2017 update | Blood Cancer Journal

  https://www.nature.com/articles/bcj201753

  The cytogenetic aberration with the greatest impact on prognosis and treatment is the presence of the Philadelphia chromosome, t(9;22). […] Ph-positivity has implications both in terms of prognosis and for treatment. Historically, Ph-positive ALL has a 1-year survival of around 10%. However, with the development of TKIs, survival has improved and thus the Ph-status of all patients must be obtained prior to starting therapy. […] More recently, a subset of high-risk ALL without t(9;22) has been identified with a genetic profile similar to that of Ph-positive ALL. This so called, Ph-like ALL has been associated with poor response to induction chemotherapy, elevated minimal residual disease and poor survival. […] In addition to disease characteristics at the outset, it has long been recognized that response to initial therapy predicts outcome.

• #2 Prognosis and survival for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/prognosis-and-survival

  The response to chemotherapy is measured as the time it takes to reach a complete remission, or complete response. When a complete remission is reached within 4 weeks of starting chemotherapy, the prognosis is more favourable. The prognosis is less favourable when it takes longer to reach complete remission. The prognosis is poorer in people who dont reach a complete remission after chemotherapy. […] An early relapse means that the leukemia returns soon after treatment. It is a poor prognostic factor. […] Spread of ALL to the brain and spinal cord (called the central nervous system, or CNS) is a poor prognostic factor. […] People with ALL are divided into the following prognostic risk groups: Good risk means that the person with ALL has a more favourable prognosis. […] Poor risk means that the person with ALL has a less favourable prognosis. People in the poor risk group: have unfavourable chromosome abnormalities t(9;22), t(4;11), are older than 60 years of age, have ALL with a WBC count greater than 100,000, do not reach a complete remission within 4 weeks.

• #2 Prognostic Factors in Childhood Leukemia (ALL or AML) | American Cancer Society

  https://www.cancer.org/cancer/types/leukemia-in-children/detection-diagnosis-staging/prognostic-factors.html

  How well (and how quickly) ALL or AML responds to the initial (induction) treatment can affect long-term prognosis. […] A remission (or complete remission) is usually defined as having no evidence of leukemia after the initial treatment. […] In general, children with MRD during or after induction chemotherapy are more likely to have the leukemia relapse (come back) and therefore may need more intense treatment. Children with more MRD have a greater risk of relapse than those with less MRD.

• #2 Acute Lymphocytic Leukemia

  https://www.cancernetwork.com/view/acute-lymphocytic-leukemia

  The prognosis of mature B-cell ALL is changing; favorable outcomes have been reported with the use of recent short-term, dose-intensive regimens. […] The expression of myeloid markers has been difficult to evaluate as a prognostic factor, mostly because of different diagnostic criteria. […] Other Prognostic Factors: CD34 expression has been correlated with a favorable outcome in children with the pre-B-cell phenotype but has not in adults. […] Prognostic Models: With all these risk factors, several prognostic models have been proposed.

• #2 Refining risk prediction in pediatric acute lymphoblastic leukemia through DNA methylation profiling | Clinical Epigenetics | Full Text

  https://clinicalepigeneticsjournal.biomedcentral.com/articles/10.1186/s13148-024-01662-6

  However, relapsed patients face slower progress, with a mortality rate of approximately 45% in Nordic countries. […] Prognostic factors have been used to estimate the risk of relapse and to adjust treatment intensity accordingly, which has resulted in reduced toxicity without adversely impacting the rate of curation. […] The RRP achieved c-indexes of 0.667 and 0.677 in the training and test sets, respectively. […] The MRP achieved c-indexes of 0.751 and 0.754 in the training and test sets, respectively. […] The MRP provided its best prognostic accuracy within the standard and infant risk groups. […] Our research presents two innovative models utilizing DNA methylation data for predicting relapse and mortality risk (RRP and MRP) in pediatric ALL. These models surpass traditional cytogenetic and clinical prognostic methods in risk stratification.

• #2 Acute lymphoblastic leukemia: a comprehensive review and 2017 update | Blood Cancer Journal

  https://www.nature.com/articles/bcj201753

  Poor MRD clearance, defined as levels 1 x 10^3 after induction and levels 5 x 10^4 after early consolidation by flow cytometry, was the only significant prognostic factor for disease-free and overall survival. […] Allo-SCT has long been considered the standard of care and best chance for a durable response. […] It is therefore recommended that all high-risk young adults with an available donor undergo Allo-SCT during their first CR (CR1). […] The role of Allo-SCT in standard-risk adults is less clearly defined. […] In patients with positive MRD, Allo-SCT was associated with improved relapse-free survival. However, in patients with a complete MRD response, there was no survival benefit to Allo-SCT over standard chemotherapy. […] The successes from tyrosine kinase inhibition in CML have been translated to Ph-positive ALL, and second and third generation TKIs are being studied for use in high-risk Ph-like disease. […] As the role of these novel agents is further defined and integrated into new treatment strategies, adult ALL may follow pediatric ALL as a major success story in the near future.

• #2 SciELO Brazil – Adult acute lymphoblastic leukemia Adult acute lymphoblastic leukemia

  https://www.scielo.br/j/rbhh/a/vf6ZN8dbgCP7ZptNmrCRN3g/?lang=en

  The diagnostic methods aimed at defining ALL subgroups with a different prognostic likelihood have substantially broadened in recent years. […] The new risk stratification algorithm of adult ALL is more complex and is based on earlier „conventional parameters”, such as clinical characteristics including age, white blood cell count, organ involvement (e.g. CNS, mediastinum, extramedullary involvement); immunophenotype; cytogenetic aberrations and molecular genetics; monitoring of MRD. […] Young adult patients between 15 and 20 years of age with ALL represent a unique epidemiologic group in that they may be treated by either adult or pediatric hematologists. […] Recent data suggest that the outcome of this subgroup of patients is markedly improved if they are treated on intensive pediatric ALL protocols rather than on less intensive adult ALL protocols. […] It is easy to foresee that the continuous refinement of technological tools, aimed at an ever more sophisticated characterization of ALL cells, will progressively lead to an ever greater use of targeted strategies in the management of patients of all ages suffering from ALL.

• #3 Prognosis and survival for acute lymphoblastic leukemia | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/acute-lymphoblastic-leukemia-all/prognosis-and-survival

  People with acute lymphoblastic leukemia (ALL) may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a persons medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] A prognosis is the doctors best estimate of how cancer will affect a person and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.

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