From the Guidelines
The primary concern for Acute Lymphoblastic Leukemia (ALL) in a 12-month-old with lymphocytosis is the potential for a poor prognosis and the need for prompt diagnosis and treatment.
Key Considerations
- Age: The median age at diagnosis for ALL is 15 years, but it is the most common pediatric malignancy, representing 75%–80% of acute leukemias among children 1.
- Lymphocytosis: The presence of lymphocytosis in a 12-month-old child may indicate ALL, and a bone marrow biopsy is necessary to confirm the diagnosis 1.
- Risk Stratification: The NCCN Guidelines for Pediatric ALL provide recommendations on risk assessment and stratification of patients, which is critical for determining the best course of treatment 1.
Diagnostic Evaluation
- Bone Marrow Biopsy: A bone marrow biopsy is necessary to confirm the diagnosis of ALL and to assess the presence of specific genetic abnormalities 1.
- Immunophenotyping: Comprehensive immunophenotyping with flow cytometry is essential for identifying the specific subtype of ALL and for determining the best course of treatment 1.
- Cytogenetic and Molecular Subtypes: The identification of specific recurrent genetic abnormalities is critical for disease evaluation, optimal risk stratification, and treatment planning 1.
Treatment
- Risk-Adapted Therapy: The treatment approach to ALL represents one of the most complex and intensive programs in cancer therapy, and risk-adapted therapy is essential for improving outcomes 1.
- Targeted Agents: The use of targeted agents, such as tyrosine kinase inhibitors, may be beneficial for patients with specific genetic abnormalities, such as BCR-ABL1-positive ALL 1.
From the Research
Concerns for Acute Lymphoblastic Leukemia (ALL) in a 12-month-old with Lymphocytosis
- The presence of lymphocytosis in a 12-month-old child may indicate a potential risk for Acute Lymphoblastic Leukemia (ALL) 2, 3.
- ALL is a type of blood cancer that is common in children, and its prognosis depends on various factors, including age, white blood cell count, and cytogenetics 3, 4.
- A high absolute lymphocyte count (ALC) is associated with a better prognosis in patients with ALL, while a low ALC is associated with a poorer prognosis 2.
- The treatment and management of ALL in children have improved significantly over the years, with a cure rate of 60-70% in children 3, 4.
- However, the outcome for infants and young children with ALL remains a concern, and further research is needed to improve treatment options and outcomes for this age group 5, 6.
Prognostic Factors for ALL
- Age is an important prognostic factor for ALL, with infants and young children having a poorer prognosis than older children 3, 4.
- White blood cell count and cytogenetics are also important prognostic factors, with certain genetic abnormalities associated with a poorer prognosis 3, 4.
- The presence of minimal residual disease (MRD) is also a prognostic factor, with patients having MRD-positive disease having a higher risk of relapse 6.
Treatment Options for ALL
- Chemotherapy is the primary treatment for ALL, with the goal of achieving complete remission 3, 4.
- Immunotherapy, including monoclonal antibodies and chimeric antigen receptor (CAR) T cells, is a promising new treatment option for ALL 5, 4.
- Hematopoietic stem cell transplantation (HSCT) may also be an option for certain patients with ALL, particularly those with high-risk disease or relapsed/refractory disease 3, 6.