Prognosis:

Acute lymphocytic leukemia is responsible for about 1,400 deaths a year in the U.S., and it can progress quickly if untreated. However, ALL is one of the most curable cancers and survival rates are now at an all-time high.

According to the American Cancer Society, certain factors can help determine prognosis:

• Age. Younger patients (especially those younger than age 50) have a better prognosis than older patients.
• Initial white blood cell (WBC) count. People diagnosed with a WBC count below 50,000 tend to do better than people with higher WBC counts.
• ALL subtype. The subtype of T cell or B cell affects prognosis. For example, patients with T-cell ALL tend to have a better prognosis than those with mature B-cell ALL (Burkitt leukemia.)
• Chromosome translocations. People who have Philadelphia chromosome-positive ALL tend to have a poorer prognosis, although new treatments are helping many of these patients achieve remission.
• Response to chemotherapy. Patients who achieve complete remission (disappearance of signs and symptoms of cancer) within 4 - 5 weeks of starting treatment tend to have a better prognosis than those who take longer. Patients who do not achieve remission at any time have a poor prognosis. Evidence of minimal residual disease (presence of leukemia cells in the bone marrow) may also affect prognosis.

Other factors, such as central nervous system involvement or recurrence, may also indicate a poorer prognosis.

Outlook in Children with ALL. More than 95% of children with ALL attain remission.

Certain children are at higher risk for a poor outcome than others:

• Infants and children age 10 years and older tend to have a poorer outcome than young children (ages 1 - 9 years).
• Some studies indicate a better prognosis for girls than boys. This may be partly due to boysâ ' risks for testicular cancer.
• Survival rates for African-American and Hispanic children are lower than Caucasian and Asian children, but this may be due to poorer access to treatment.

Responding well to early treatment is a good sign regardless of the risk category. Other positive predictors include:

• Less than 5% of cells being blasts after 7 - 14 days of treatment
• Less than 1,000 blasts per microliter on peripheral smear after 7 days

Outlook in Adults with ALL. Adults tend to have a more severe condition than children, even if they are carrying the same ALL genes. Still, 60 - 80% of adults with ALL can expect to achieve full remission with standard treatments, and 35 - 40% survive beyond 2 years with aggressive treatments. Younger adults with ALL have better long-term survival rates than older adults with the disease.