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ALL Risk Stratification — RACP Paediatrics MCQ

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HardHaematology & OncologyALL Risk StratificationRACP Paediatrics

A 4-year-old presents with fever, bone pain, hepatosplenomegaly, and cervical lymphadenopathy. FBC shows Hb 68 g/L, WCC 85 x 10^9/L with 90% blasts, and platelets 15. Bone marrow shows >90% lymphoblasts positive for CD10, CD19, TdT. What is the risk stratification factor most associated with a favourable prognosis?

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Correct answer: B — Age 1-9 years and WCC <50 x 10^9/L

In childhood ALL, standard risk (favourable prognosis) is defined as age 1-9 years and presenting WCC <50 x 10^9/L. Other favourable factors include pre-B immunophenotype, hyperdiploidy, and ETV6-RUNX1 fusion. High-risk features include age <1 or >10, WCC >50, T-cell, hypodiploidy, KMT2A rearrangement, and Philadelphia chromosome.

Reference: ANZCHOG – 2024 – Treatment Guidelines: ALL