Age at diagnosis: children 1–10 years of age are most likely to develop ALL and to be cured of it. Cases in older people are more likely to result from chromosomal abnormalities (e.g., the Philadelphia chromosome) that make treatment more difficult and prognoses poorer. Older people are also likely to have co-morbid medical conditions that make it even more difficult to tolerate ALL treatment. White blood cell count at diagnosis of greater than 30,000 (B-ALL) or 100,000 (T-ALL) is associated with worse outcomes
Cancer spreading into the Central nervous system (brain or spinal cord) has worse outcomes. Morphological, immunological, and genetic subtypes
Persons response to initial treatment and longer length of time required (greater than 4 weeks) to reach complete remission
Early relapse of ALL
Minimal residual disease
Genetic disorders, such as Down syndrome, and other chromosomal abnormalities (aneuploidy and translocations)Cytogenetics, the study of characteristic large changes in the chromosomes of cancer cells, is an important predictor of outcome. Some cytogenetic subtypes have a worse prognosis than others. These include:
Person with t(9,22) positive-ALL (30% of adult ALL cases) and other Bcr-abl-rearranged leukemias are more likely to have a poor prognosis, but survival rates may rise with treatment consisting of chemotherapy and Bcr-abl tyrosine kinase inhibitors. A translocation between chromosomes 4 and 11 occurs in about 4% of cases and is most common in infants under 12 months.Hyperdiploidy (>50 chromosomes) and t(12;21) are good prognostic factors and also makeup 50% of pediatric ALL cases.Unclassified ALL is considered to have an intermediate prognosis risk, somewhere in-between the good and poor risk categories.
Typical treatment involves a Needle aspiration biopsy which is typically done with a 10 cc syringe attached to a fine needle aspiration needle. Fine needle aspiration allows retrieval of cytological samples that can be sent for pathological review to determine if the cyst is benign or malignant. Aspirated cysts often recur (come back); definitive treatment may require surgery. During an excisional biopsy an incision is made around the mass creating a superior and inferior flap. The mass is dissected out followed by confirmation of hemostasis. Once hemostasis is confirmed the wound is closed with an absorbable suture. The mass is then sent to pathology for review. Pathology can help determine if the surgeon needs to dissect a bigger margin. Draining the fluid and then waiting for the cyst to resolve is the main treatment applied in these cases. Moreover, if cysts are aspirated and the fluid looks normal, they do not require any other medical attention apart from following-up to make sure they have completely disappeared. Hormone therapy, by the means of oral contraceptives, is sometimes prescribed to reduce their recurrence and to regulate the menstrual cycle of the patient (which is likely to cause them in the first place). Danazol may also be prescribed to treat this condition and it is usually considered in patients on whom the non-medical treatment fails and the symptoms are intense. Surgical removal of a breast cyst is necessary only in a few unusual circumstances.