Which among the following is poor prognostic indicator in ALL in children?
Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood. The diagnosis of ALL is made by bone marrow examination, which shows a homogeneous infiltration of leukemic blasts replacing normal marrow elements. Two most impoant prognostic features are WBC count and age. Children less than one year of age have a very poor prognosis. Infant leukemia is often associated with a genetic abnormality t(4;11) translocation and has high WBC count. Children aged 1-9 years have good prognosis. WBC count more than 50,000/L at diagnosis is associated with a poor prognosis. Cure rates depend on specific prognostic features present at diagnosis, biologic features of the leukemic blast, and the response to therapy. Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Age
TLC 4000-10,000
Presence of testicular involvement at presentation
Presence of blasts in peripheral smear