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Essay: The Prognosis of Treatment in Childhood ALL Patients
One of the first questions in the minds of parents and asked of the oncologist is: What are the chances that my child will be cured? Many of us like to put a number on our child's ability to survive their cancer. This is not a good practice. A "ten in a hundred" chance of survival means your child is likely to be one of the ten. Think of the cup as "half full" and not "half empty". In spite of this, we do ponder our child's prognosis in the dark hours of the night.
Why can't they tell us whether or not they can cure our child of ALL? Why is my doctor hedging in his or her answer?
The reason? The answer depends on so many inter-related and complex variables that it cannot be absolutely determined. I will address and try to describe some of these variables in the following discussion. Bear with me, this is a difficult subject for a mere parent to broach. Leukemia is being studied in detail by scientists with years of training and years of building up a "language" with which we are not familiar; many of the terms reported in the scientific literature mean little to the lay person.
Keep in mind that a "good prognosis" is just that, it is not a guarantee of success, nor is an "unfavorable prognosis" as bad as it sounds.
The many variables of each child's cancer and their influence on the outcome of treatment are being researched in clinical trials. Certain factors have already been found to indicate a more or less favorable outcome and currently determine the intensity of the treatment in many treatment protocols in the US. Adhering to a set of standards sets a framework to compare treatment approaches. Certain factors at diagnosis - age less than 10, WBC less than 50,000, B cell - were accepted in the late 1990s as leading to a more favorable outcome and put the child on a less agressive treatment plan. (In the early 2000s, certain cytogenetic factors were added to the mix of prognostic factors.)
This risk-based approach to treatment has improved survival and reduced toxic effects. Certain protocols use additional variables to track patients to greater or lesser aggressive treatments. These include: CNS (central nervous system) involvement, hyperdiploidy, karyotype, morphology, and early response of the cancer cells to chemotherapy. Still other factors are being recorded and their influence on treatment outcome monitored: lymphomatous presentation, platelet count, hemoglobin level, race, sex, serum immunoglobulin levels, peripheral blood and marrow response to treatment, rate of cytoreduction, and biochemical characteristics.
Hopefully the discussion on prognostic factors section clarifies the terms in the detailed description of your child's leukemia. Probably, your oncologist will not hand you this information unless you ask for it. But the tests were done; it is required for the clinical trials. Your oncologist probably does not think that you will understand the terms in the records, and from the above discussion you may see why! Also, you may not need or want to know these details. Many of these variables are only now being monitored; some have been already been designated favorable or unfavorable.
Above all, do not panic if you find a "less favorable" in the details of your child's cancer. It's just that, less favorable, it is not a prediction of failure. It is, however, likely to mean that your child will undergo a more intense treatment. The outcome should be the same: event free survival.
P.S. I strongly recommend reading Steve Dunn's "Pros and Cons of Researching Your Cancer", just substitute in your mind "your kid's cancer".
These pages are intended for informational purposes only and are not intended to render medical advice. The information provided on Ped Onc Resource Center should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you suspect your child has a health problem, you should consult your health care provider.