The Prognosis for Childhood Acute Lymphoblastic Leukemia
The improvement in survival for childhood acute lymphoblastic
leukemia over the past 35 years is one of the great success stories of cancer treatment. In the 1960s, less than 5 percent of children with ALL survived for more than five years. Today, approximately 85 percent of children with ALL will live five years or more after diagnosis.
The chance of survival for children with ALL is dependent upon a number of factors. The most important factor is receiving optimal care at a center experienced in the treatment of childhood acute lymphoblastic leukemia. However, even with optimal care, some children with ALL are much more difficult to treat successfully than others.
In the past, factors such as age and white blood cell count at diagnosis were commonly used to predict outcome. For example, children who are 1 to 9 years of age have higher survival rates than infants or older children. However, factors such as age and white blood cell count at diagnosis are, at best, crude predictors of outcome.
It is now clear that the patient's subtype of ALL has a powerful impact on survival. For example, infants commonly have a subtype of ALL in which a specific gene is modified. This subtype of ALL is very hard to treat successfully, and only a minority of infants with this subtype of ALL will survive with current therapy. Other subtypes of ALL in which different genes are modified occur more commonly in older children and have a much more favorable outcome.
It is now common practice for the
leukemia cells of children with ALL to be tested for the gene modifications. The type of treatment is then based on the particular change that is seen in the leukemia cells.
Childhood Acute Lymphoblastic Leukemia: Summary
Key information about childhood acute lymphoblastic leukemia includes:
- Acute lymphoblastic leukemia (ALL) is a cancer of the white blood cells, which are the cells in the body that normally fight infection.
- In childhood acute lymphoblastic leukemia, the abnormal cells may collect in the brain or spinal cord, also called the central nervous system (CNS).
- In cancers such as leukemia that appear throughout the body during their earliest stages, screening does not appear to be useful. Instead, children with possible symptoms of acute lymphoblastic leukemia should see their physician.
- Although leukemia cells from different children with acute lymphoblastic leukemia often look similar under the microscope, there are actually many distinctive subtypes of ALL.
- With the exception of prenatal exposure to x-rays and specific genetic syndromes, such as Down syndrome, little is known about the causes of and risk factors for childhood acute lymphoblastic leukemia.
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