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Risk group stratification and prognosis for acute lymphoblastic leukemia in children and adolescents

Authors
Terzah M Horton, MD, PhD
C Philip Steuber, MD
Section Editor
Julie R Park, MD
Deputy Editor
Alan G Rosmarin, MD

INTRODUCTION

Acute leukemia is the most common form of cancer in children, comprising approximately 30 percent of all childhood malignancies [1]. Of the acute leukemias, acute lymphoblastic leukemia (ALL) occurs five times more commonly than acute myeloid leukemia (AML). Survival rates for ALL have improved dramatically since the 1980s, with a current five-year overall survival rate estimated at greater than 90 percent [1-4]. This improvement in survival is due to treatment of a large number of children on sequential standardized research protocols. Approximately 75 to 80 percent of children with newly diagnosed ALL participate in such trials, the goals of which are to improve clinical outcomes while minimizing acute toxicities and late-occurring adverse events.

The risk group stratification for acute-lymphoblastic leukemia in children will be reviewed here. The presentation, classification, treatment, and outcome of childhood ALL are discussed separately. (See "Overview of the presentation and diagnosis of acute lymphoblastic leukemia in children and adolescents" and "Overview of the treatment of acute lymphoblastic leukemia in children and adolescents".)

OVERVIEW

Current treatment protocols for ALL in children emphasize risk-based therapy in order to reduce toxicity in low risk patients while ensuring appropriate, more aggressive therapy for those with a high risk of relapse. The development of such risk-based therapy regimens and the introduction of preventive central nervous system (CNS) therapy have helped to improve survival rates for children with ALL.

Certain clinical and laboratory features have been historically correlated with prognosis (table 1). Features that continue to be used in risk stratification include:

Initial white blood cell (WBC) count

              

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