Question:medium
Which of the following is a poor prognostic factor in acute lymphoblastic leukemia (ALL)?
Which of the following is a poor prognostic factor in acute lymphoblastic leukemia (ALL)?
Show Hint
The Philadelphia chromosome and MLL rearrangement signal a bad outcome.
Updated On: Jun 24, 2026
- Hyperdiploidy
- t(9;22) and t(4;11)
- Age 2 to 8 years
- Total leukocyte count < 50000
Show Solution
The Correct Option is B
Solution and Explanation
Approach the item by sorting each factor into the favourable or unfavourable column of ALL risk stratification. Three of the four listed features carry a good outlook: hyperdiploidy with a chromosome count above 50 predicts an excellent response; presentation at an age of roughly 2 to 8 years lies in the low-risk window; and a leukocyte count under 50000 at diagnosis is itself a favourable threshold. The single entry that signals a bad outcome is the cytogenetic pair t(9;22) and t(4;11). The first is the Philadelphia chromosome producing BCR-ABL, and the second is an MLL gene rearrangement seen often in infant ALL; both are linked to chemoresistance and frequent relapse. Therefore the translocations are the adverse factor the question wants.
$ \text{good} = \{\text{hyperdiploidy, age 2-8, TLC} < 50000\},\ \text{poor} = t(9;22),\,t(4;11) $
\[\boxed{\text{t(9;22) and t(4;11)}}\]
$ \text{good} = \{\text{hyperdiploidy, age 2-8, TLC} < 50000\},\ \text{poor} = t(9;22),\,t(4;11) $
\[\boxed{\text{t(9;22) and t(4;11)}}\]
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