Among children with B-cell acute lymphoblastic leukemia, which combination of presenting features confers the most favorable prognosis?
- A Age over 10 years, hypodiploidy (fewer than 44 chromosomes)
- B Age under 1 year, hyperleukocytosis, t(4;11) KMT2A rearrangement
- C Age 1 to 10 years, low leukocyte count, hyperdiploidy (more than 50 chromosomes) ✓
- D Any age with t(9;22) BCR-ABL1 rearrangement
Correct answer: C. Age 1 to 10 years, low leukocyte count, hyperdiploidy (more than 50 chromosomes)
Explanation
Favorable-risk pediatric B-ALL is defined by age 1 to 10 years, initial leukocyte count below 50,000 per microliter, and hyperdiploidy with more than 50 chromosomes, particularly trisomies of chromosomes 4 and 10, which correlates with excellent cure rates. Infants with KMT2C-rearranged leukemia, hypodiploid cases, and Ph-positive ALL all portend poor outcomes and require intensified or targeted therapy. Hypodiploidy and t(9;22) are among the strongest adverse cytogenetic markers in this disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.