Home >> Exams >> MD MS EE >> AIPGMEE >> AIPGMEE 2007 >> ForumTopic: LEUKEMIA QUESTION
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| nanu Total Posts: 228 | Posted: Sat Jan 27, 2007 05:57 am Q51) Good prognostic factors in childhood leukemia are all except ? A) Common ALL subtype B) pre-B ALL C) Hyperploidy D) Female gender Expected Correct Ans: Female gender CORRECT ANS IS B) pre-B ALL REFERENCE--Cytomorphologic differentiation of common acute lymphoblastic leukemia from other immunologic subtypesPMID: 3901644 [PubMed - indexed for MEDLINE] 1.Of the subtypes of acute lymphoblastic leukemia (ALL), the "common" subtype (c-ALL) bears the best prognosis. 2. Copyright (c) 2006-2007, Institute for Algorithmic Medicine, Houston, TX, USA. All rights reserved. Overview : Identification of significant risk factors in a patient helps in selecting the optimum treatment protocol for that patient, permitting a more or less aggressive approach as needed. Parameters: (1) age (2) initial white blood cell count (3) sex (4) race (5) cytogenetics (6) immunophenotype (7) FAB morphology (Cool organomegaly (9) mediastinal mass (10) lymphadenopathy (11) hemoglobin (12) LDL (13) platelet count (14) serum immunoglobulins (15) rapidity of leukemic cytoreduction on induction therapy (16) response to initial course of induction chemotherapy Parameter Finding Prognosis age < 12 months very poor 12-23 months poor (?) 2 - 10 years good > 10 years poor initial white blood cell count > 200,000 per µL very poor > 50,000 per µL poor < 10,000 good sex females good males poor race Blacks poor cytogenetics hyperdiploidy (> 50 chromosomes) good hypoploidy poor t (8;14) very poor (induction failure and early relapse) t (9;22) (Philadelphia chromosome) very poor (induction failure and early relapse) t (4;11) poor (induction failure and early relapse) dicentric translocation involving short arms of 9 and 12 good t (1;19) and pre-B immunophenotype (not early pre-B) poor MLL gene rearrangement in infants very poor immunophenotype early pre-B cell (no cytoplasmic immunoglobulin) good pre-B cell (cytoplasmic immunoglobulin) poor mature B cell very poor T cell poor myeloid markers present poor FAB morphology L3 poor L2 poor L1 good mediastinal mass present poor organomegaly hepatomegaly poor splenomegaly poor lymphadenopathy present poor hemoglobin level LDH platelet count serum immunoglobulins low IgM poor low IgG and/or IgA poor rapidity of leukemic cytoreduction on induction therapy residual leukemia on day 14 of induction therapy poor response to initial course of induction chemotherapy failure to achieve complete remission poor where: • The relationship between initial WBC count and prognosis is linear and continuous, with the prognosis inversely related to the count. • The worse prognosis in males is related to testicular relapse and the higher rate of T cell ALL. • The worse prognosis in Blacks is associated with an increased frequency of very high initial white blood cell counts, mediastinal mass, and L2 morphology. • Mediastinal mass, hepatomegaly, splenomegaly and lymphadenopathy reflect high initial tumor burden and correlation with the initial WBC count. • > 1,000 blasts per µL one week after preliminary treatment with glucocorticoids and intrathecal methotrexate is a poor prognostic finding (Arico et al) |
| Admin Total Posts: 890 | Posted: Mon Jan 29, 2007 04:01 am updated |