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1520 Part XI: Malignant Lymphoid Diseases Chapter 91: Acute Lymphoblastic Leukemia 1521

TABLE 91–7. Adverse Prognostic Factors in Adult Acute TABLE 91–8. Risk Classification System Used in St. Jude
Lymphoblastic Leukemia Total Therapy Study XVI
Factors Precursor B Cell Precursor T Cell Risk Group Feature
Age (years)* >35 >35 Standard Precursor B-cell phenotype in patients ages 1–9
Leukocyte count >30 >100 years with a presenting leukocyte count <50 ×
9
(×10 /L) 10 /L, ETV6-RUNX1 fusion, or hyperdiploidy (>50
9
chromosomes or DNA index >1.16)
Immunophenotype Pro-B (CD10–) Pre-T
Must not have CNS3 status, testicular leukemia,
Genetics t(9;22) [BCR-ABL1] HOX11L2 t(9;22), t(1;19), rearranged MLL gene, hypodiploidy,
expression? or ≥0.01% leukemia cells in marrow after 6-week
t(4;11) [MLL-AF4] ERG expression? remission induction
Hypodiploidy? High T-cell acute lymphoblastic leukemia (ALL) and all
cases of B-cell precursor ALL that do not meet the
Treatment response Delayed remission Delayed remission criteria for standard or very-high-risk ALL
(>4 weeks) (>4 weeks)
Very high Early T-cell precursor, initial induction failure, or
Minimal residual Minimal residual ≥1% leukemic cells in marrow after 6-week remis-
disease >10 after disease >10 after sion induction
–4
–4
induction induction
* Continuous factor with increasing age associated with progressively
worse outcome.

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