Pretherapeutic factors associated with outcome in adult ALL81-83
| Factor . | Category . | Prognostic impact . | Potential impact on targeted therapy . |
|---|---|---|---|
| Age | — | Worse outcome with advancing age84,85 | — |
| White blood cell count at diagnosis | B: > 30 × 109/L (B) | High WBC associated with poor prognosis84,85 | — |
| T: > 100 × 109/L (T) | |||
| Immunophenotype | CD20 expression | Conflicting data concerning prognosis74,75 | Monoclonal antibodies |
| T versus B | Independent prognostic significance (T-ALL with better prognosis) mainly in early studies84,85 | Monoclonal antibodies Bispecific T-cell engager nelarabine | |
| Cytogenetics | t(9;22)/BCR-ABL | Poor prognosis86,87 | TKI |
| t(4;11)/MLL-AF4 | Poor prognosis86,87 | — | |
| t(8;14) | |||
| Hypodiploidy* | |||
| Near triploidy | |||
| Complex karyotype† | |||
| t(1;19) | Conflicting data concerning prognosis88,89 | — | |
| High hyperdiploidy‡ | Better prognosis86 | — | |
| del(9p) | |||
| Specific molecular alterations | JAK mutations | Emerging significance of poor prognosis90 | JAK inhibitors |
| IKZF Deletions/sequence mutations | Emerging significance of poor prognosis91,92 | ||
| CRLF2 overexpression | Emerging significance (mainly childhood ALL) of poor prognosis92 | CRLF antibodies | |
| ERG/BAALC expression | Conflicting data concerning prognosis93,94 | ||
| NOTCH1 mutations | Conflicting data concerning prognosis95,96 | NOTCH1 targeting |
| Factor . | Category . | Prognostic impact . | Potential impact on targeted therapy . |
|---|---|---|---|
| Age | — | Worse outcome with advancing age84,85 | — |
| White blood cell count at diagnosis | B: > 30 × 109/L (B) | High WBC associated with poor prognosis84,85 | — |
| T: > 100 × 109/L (T) | |||
| Immunophenotype | CD20 expression | Conflicting data concerning prognosis74,75 | Monoclonal antibodies |
| T versus B | Independent prognostic significance (T-ALL with better prognosis) mainly in early studies84,85 | Monoclonal antibodies Bispecific T-cell engager nelarabine | |
| Cytogenetics | t(9;22)/BCR-ABL | Poor prognosis86,87 | TKI |
| t(4;11)/MLL-AF4 | Poor prognosis86,87 | — | |
| t(8;14) | |||
| Hypodiploidy* | |||
| Near triploidy | |||
| Complex karyotype† | |||
| t(1;19) | Conflicting data concerning prognosis88,89 | — | |
| High hyperdiploidy‡ | Better prognosis86 | — | |
| del(9p) | |||
| Specific molecular alterations | JAK mutations | Emerging significance of poor prognosis90 | JAK inhibitors |
| IKZF Deletions/sequence mutations | Emerging significance of poor prognosis91,92 | ||
| CRLF2 overexpression | Emerging significance (mainly childhood ALL) of poor prognosis92 | CRLF antibodies | |
| ERG/BAALC expression | Conflicting data concerning prognosis93,94 | ||
| NOTCH1 mutations | Conflicting data concerning prognosis95,96 | NOTCH1 targeting |
— indicates not applicable; CRLF2, cytokine receptor-like factor 2; ERG, v-ets erythroblastosis virus E26 oncogene homolog (avian); BAALC, brain and acute leukemia, cytoplasmic; IKZF, IKAROS family zinc finger; JAK, Janus kinase; TKI, tyrosine kinase inhibitors; and WBC, white blood cell count.
< 44 chromosomes/leukemic cell.
> 5 abnormalities.
> 50 chromosomes/leukemic cell.