Classification and prognosis for ALL

Classification

Working out the specific type of ALL is called classification. It helps doctors work out the prognosis and suggest the most suitable treatment.

ALL is divided into several subtypes according to the type of lymphocyte (B-cell or T-cell) that has become abnormal and whether the Philadelphia chromosome is present. These tests look for these changes.

Some people have a type of leukaemia called biphenotypic acute leukaemia, also called ambiguous lineage leukaemia or, simply, acute leukaemia. This means the disease has features of both ALL and acute myeloid leukaemia (AML).

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor. It is not possible for anyone to predict the exact course of the disease, but your doctor can give you an idea about the issues that affect people with your type of ALL.

Test results, the exact type of ALL, whether you have certain changes in the genes (including the Philadelphia chromosome), your white cell count, and other factors such as age, fitness and medical history are all important factors in assessing your prognosis. Your doctor will also look at how quickly the initial treatment controlled the leukaemia (achieved remission).

For many people, treatment can achieve remission that lasts for years, and the longer the remission has lasted, the lower the risk of recurrence. In some cases, however, ALL becomes active again (recurs) because a small number of cancer cells were left behind. This is known as minimal residual disease (MRD).

Doctors may measure a person’s MRD to work out the risk of recurrence and the need for more treatment. Ways to measure MRD include immunophenotyping and PCR.

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