WHAT ARE ‘RISK GROUPS’?
In childhood leukemia, “risk groups” are used instead of a system of “stages.” Your healthcare team will perform a series of tests to help determine your child’s type of leukemia and risk group. Once your child is diagnosed with ALL, he or she will be assigned to a risk group based on his or her age, WBC count at diagnosis, leukemia in the spinal fluid, or leukemia in the testicles. This will allow the healthcare team to determine the treatment plan during the first month. Risk groups are determined based on age at diagnosis—Children younger than 1 year or 10 years and older require more aggressive treatment. WBC count at diagnosis—Children who have a WBC count higher than 50,000 require more aggressive treatment. type of leukemia—There are different kinds of childhood leukemia; pre-B-cell ALL is the most common and T-cell ALL is less common.
central nervous system disease—Children with leukemia in their spinal fluid at diagnosis require more aggressive treatment.
disease outside the bone marrow—Sometimes leukemia cells are seen in different parts of the body (such as the testicles). If your child is found to have disease in other parts of the body (called extramedul- lary disease), the treatment needs to be more aggressive. results of cytogenetics and FISH—Leukemia cells can carry certain genetic markers or abnormalities. These markers can affect the type of treatment your child receives. Some types of ALL (such as Philadel- phia chromosome ALL [also called BCR-ABL] or mixed lineage leukemia [MLL] gene rearrangement) can be more difficult to treat and require more aggressive therapy. If there are more chromosomes, called hyperdiploid, less aggressive chemotherapy may be needed. treatment with steroids—Children who receive treatment with steroids before learning that they have leukemia may be placed in a higher-risk group. response to treatment—A bone marrow test or a blood test, called minimal residual disease (MRD), will be done on specific days during the first month of treatment. MRD is a test done on bone marrow or blood that determines if microscopic leukemia remains. It can show the presence of leukemia down to 0.01%. If the MRD is high, more aggressive treatment will be needed. Typically these tests are done after 1 week of chemotherapy and at the end of the first month of treatment. The initial risk groups at diagnosis are
average or standard risk—Includes children 1 to 9.99 years old who have a WBC count lower than 50,000 at diagnosis
high risk—Includes children younger than 1 year and 10 years or older or those with an initial WBC of 50,000 or higher at diagnosis. In addition, children with T-cell leukemia are classified in a higher-risk group. Children younger than 1 year (365 days) or those with ALL involving T-cells or mature B-cell leukemia will be treated on different treatment plans.
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Association of Pediatric Hematology/Oncology Nurses (APHON)
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