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Acute Lymphoblastic Leukaemia — RACP Paediatrics MCQ

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HardHaematology & OncologyAcute Lymphoblastic LeukaemiaRACP Paediatrics

A 3-year-old boy presents with pallor, bruising, hepatosplenomegaly, and a white blood cell count of 85 × 10⁹/L with 90% lymphoblasts on blood film. Bone marrow confirms B-cell precursor acute lymphoblastic leukaemia (ALL). Which cytogenetic finding confers the best prognosis?

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Correct answer: A — High hyperdiploidy (>50 chromosomes)

High hyperdiploidy (>50 chromosomes) and the ETV6-RUNX1 fusion [t(12;21)] are favourable prognostic factors in childhood B-cell ALL, with overall survival >90%. The Philadelphia chromosome [t(9;22)], MLL rearrangements, and hypodiploidy are associated with poor prognosis and require intensified treatment protocols.

Reference: ANZCHOG – 2024 – Treatment Guidelines: Childhood Acute Lymphoblastic Leukaemia