Chance's Cancer Facts
Many people may not be aware that Chance's leukemia subtype--MLL rearrangement/translocation--places him in a much higher risk category than those with most lymphoblastic leukemias. Here is some information you may find helpful in understanding more about his particular diagnosis.
Chance was diagnosed with acute lymphoblastic leukemia at 9.9 years of age. The facts specific to his diagnosis are as follows:
Chance was diagnosed with acute lymphoblastic leukemia at 9.9 years of age. The facts specific to his diagnosis are as follows:
- Pre-B ALL with (4;11) MLL rearrangement and CNS3 status.
- 6-8% have this type and only 2% are in his age group or above. Prognosis is extremely poor.
Factors Influencing Risk Categories
In assessing Chance's diagnosis, medical specialists determined his risk category by examining the following factors:
- High risk—WBC count 50,000/μL or greater and/or age 10 years or older.
- CNS (central nervous system; brain/spinal cord) affected
- Gender
- Race
Explanation of Risk Categories
1) White Blood Cell Count: WBC (white blood cell) count > 50,000 at diagnosis usually signifies a poorer prognosis. Patients diagnosed above this threshold have a greater chance of therapy failure.
Chance’s WBC at diagnosis was 987,000. He failed induction therapy and received an extra dose of chemotherapy medication.
2) Central Nervous System Involvement: CNS involvement aids in describing the amount of leukemic blasts found with the cerebral spinal fluid. Patient categories range from CNS1-CNS3, or traumatic tap. CNS3 means that a significant amount of blasts were discovered. It also indicates treatment failure. CNS3 status signifies an overall poorer prognosis.
3) Gender: Males typically experience greater difficulty with treatment than females. Males are greater for relapse risk within the bone marrow or CNS.
4) Race: White males are in an intermediate range risk for relapse.
Chance’s WBC at diagnosis was 987,000. He failed induction therapy and received an extra dose of chemotherapy medication.
2) Central Nervous System Involvement: CNS involvement aids in describing the amount of leukemic blasts found with the cerebral spinal fluid. Patient categories range from CNS1-CNS3, or traumatic tap. CNS3 means that a significant amount of blasts were discovered. It also indicates treatment failure. CNS3 status signifies an overall poorer prognosis.
3) Gender: Males typically experience greater difficulty with treatment than females. Males are greater for relapse risk within the bone marrow or CNS.
4) Race: White males are in an intermediate range risk for relapse.
Chance's Cancer Subtype: MLL Rearrangement/Translocation
The subtype is a way of explaining how Chance’s cancer behaves. Most lymphoblastic leukemias have a specific genetic marker CD10. Patients with this gene fall into the 90% cure rate among leukemia. However, patients with MLL rearrangement do not have the CD10 gene and their diagnosis is poorer.
Chance’s subtype rearranges the chromosomes of the cancer gene. The 4th chromosomes breaks off and affixes itself to the 11th chromosome.
MLL rearrangement occurs primarily in infants. Although children with MLL have a slightly better prognosis than infants, CNS involvement simultaneously symbolizes a poor prognosis.
Other prognostic variables:
Chance relapsed while on treatment; therefore, his response to treatment was poor. Chance also failed induction therapy. At the end of your initial therapy, the MRD status should be negative. In Chance’s case, the needed MRD status < 5% (.05). Chance did not reach first remission (negative MRD status) until ninety-four days of treatment. On day seven, Chance’s bone marrow tested positive for over 1% of positive cancer cells. By day fourteen, the number had grown. At end of induction therapy, Chance remained positive for prominent numbers of leukemic blasts.
Chance’s subtype rearranges the chromosomes of the cancer gene. The 4th chromosomes breaks off and affixes itself to the 11th chromosome.
MLL rearrangement occurs primarily in infants. Although children with MLL have a slightly better prognosis than infants, CNS involvement simultaneously symbolizes a poor prognosis.
Other prognostic variables:
- Response to treatment
- Induction failure
- Bone marrow status on day 7 and 14
- MRD (minimal residual disease)- remaining cancer cells
Chance relapsed while on treatment; therefore, his response to treatment was poor. Chance also failed induction therapy. At the end of your initial therapy, the MRD status should be negative. In Chance’s case, the needed MRD status < 5% (.05). Chance did not reach first remission (negative MRD status) until ninety-four days of treatment. On day seven, Chance’s bone marrow tested positive for over 1% of positive cancer cells. By day fourteen, the number had grown. At end of induction therapy, Chance remained positive for prominent numbers of leukemic blasts.