Potential prognostic and predictive factors in adult ALL
| . | Risk factors . | Annotations . |
|---|---|---|
| Patient-related | ||
| Age (y) | >30-60 y (continuous variable) | Independent PF, usually not affecting risk model (age-adapted protocols) |
| >55 y (older adults and elderly) | ||
| Performance (ECOG) | >1 | Retrospective data; relevance in older patients |
| Disease-related | ||
| WBC (×109/L) | >30 (B), >100 (T) | Variably considered |
| Immunophenotype | Pro-B, CD20+ (B), pro/pre-T, ETP, and mature-T (T) | Variably considered |
| Cytogenetics and fluorescence in situ hybridization | Ph+, t(4;11), hypodiploidy, and complex∗ | Key prognostic elements; beside Ph+ and KMT2Ar variably considered |
| Genetics | BCR::ABL1+, KMT2Ar | Key prognostic elements |
| Ph-like, mutated CLRF2/TP53/JAK-STAT, adverse CNA profile (B), unmutated NOTCH1/FBWX7, and abnormal RAS/PTEN (T) | Variably considered | |
| Miscellaneous | CNS involvement | Occasionally considered |
| Poor treatment compliance and undue treatment reductions and delay | Retrospective data, of greater concern with pediatric-type protocols | |
| Pharmacogenomics (affecting antimetabolite disposition) | Data in children, not usually assessed in adults | |
| Immune marrow microenvironment | Investigational, for research purposes | |
| Drug response profiling | Investigational, for research purposes | |
| Treatment-response dynamics | ||
| Corticosteroid sensitivity (prephase) | Poor prednisone response (PB count ≥1 × 109/L at the end of prephase) | Historical relevance, occasionally considered |
| Early/incomplete blast cell clearance (BM morphology) | Day 8-15 or end of induction BM blasts ≥5% | Variably considered |
| Time to CR (number of courses) | >1 cycle (late CR) | Variably considered |
| MRD (molecular/flow cytometry) | MRD positivity (from end of induction onwards): ≥0.1%/0.01% after induction ≥0.01%/positive after/during consolidation and pre/post-allogeneic SCT | Key and unifying factor predicting outcome |
| . | Risk factors . | Annotations . |
|---|---|---|
| Patient-related | ||
| Age (y) | >30-60 y (continuous variable) | Independent PF, usually not affecting risk model (age-adapted protocols) |
| >55 y (older adults and elderly) | ||
| Performance (ECOG) | >1 | Retrospective data; relevance in older patients |
| Disease-related | ||
| WBC (×109/L) | >30 (B), >100 (T) | Variably considered |
| Immunophenotype | Pro-B, CD20+ (B), pro/pre-T, ETP, and mature-T (T) | Variably considered |
| Cytogenetics and fluorescence in situ hybridization | Ph+, t(4;11), hypodiploidy, and complex∗ | Key prognostic elements; beside Ph+ and KMT2Ar variably considered |
| Genetics | BCR::ABL1+, KMT2Ar | Key prognostic elements |
| Ph-like, mutated CLRF2/TP53/JAK-STAT, adverse CNA profile (B), unmutated NOTCH1/FBWX7, and abnormal RAS/PTEN (T) | Variably considered | |
| Miscellaneous | CNS involvement | Occasionally considered |
| Poor treatment compliance and undue treatment reductions and delay | Retrospective data, of greater concern with pediatric-type protocols | |
| Pharmacogenomics (affecting antimetabolite disposition) | Data in children, not usually assessed in adults | |
| Immune marrow microenvironment | Investigational, for research purposes | |
| Drug response profiling | Investigational, for research purposes | |
| Treatment-response dynamics | ||
| Corticosteroid sensitivity (prephase) | Poor prednisone response (PB count ≥1 × 109/L at the end of prephase) | Historical relevance, occasionally considered |
| Early/incomplete blast cell clearance (BM morphology) | Day 8-15 or end of induction BM blasts ≥5% | Variably considered |
| Time to CR (number of courses) | >1 cycle (late CR) | Variably considered |
| MRD (molecular/flow cytometry) | MRD positivity (from end of induction onwards): ≥0.1%/0.01% after induction ≥0.01%/positive after/during consolidation and pre/post-allogeneic SCT | Key and unifying factor predicting outcome |
∗Definition of complex karyotype: 5 or more chromosomal abnormalities excluding those patients with an established translocation.38
CNS, central nervous system; ECOG, Eastern Cooperative Oncology Group; and ETP, early thymic precursor.