Acute Lymphoblastic Leukemia Patient & Family Handbook

The results from the cytogenetic testing and your child’s response to the initial treatment also will be used to further determine the risk group; however, these results will not be available until your child is 2–4 weeks into therapy. Cytogenetics results can shift your child into a lower or higher risk category. All these risk factors help the healthcare team determine your child’s prognosis and will be used to identify the best treatment plan. Further treatment decisions will be made approximately 1 month into treatment when this additional information is known. After the first month of therapy, each child is placed in one of four risk groups.

LOW RISK

Children between the age of 1 and 9.99 years old with a WBC count lower than 50,000 at diagnosis and all of these criteria: no testicular disease no leukemia in their spinal fluid at diagnosis have “good or favorable” chromosome alterations in leukemia cells (these are called ETV6/RUNX1 fusion or trisomy 4,10) do not have Down syndrome did not receive steroids before diagnosis MRD less than 0.01% after first week of chemotherapy and at the end of the first month of chemotherapy.

AVERAGE OR STANDARD RISK

Children younger than 1 year and 10 years or older with a WBC count lower than 50,000 at diagnosis and all of these criteria: no testicular disease very little leukemia in their spinal fluid at diagnosis (called CNS-2) have “good or favorable” chromosome alterations in leukemia (ETV6/RUNX1 fusion or trisomy 4,10) do not have Down syndrome did not receive steroids before diagnosis MRD in the first week of treatment of 0.01% or more, and MRD at the end of the first month of treatment of LESS than 0.01%. AVERAGE RISK WITH DOWN SYNDROME

children older than 1 year and younger than 10 years who have been diagnosed with Down syndrome WBC count lower than 50,000 at diagnosis no testicular disease no leukemia in their spinal fluid at diagnosis no unfavorable cytogenetics such as MLL-rearrangement, hypodiploidy, or Philadelphia chromosome (also called BCR-ABL).