Prognosis of acute lymphoblastic leukemia (ALL) in childhood. Results of the French protocol FRALLE 93

1 120 children were included in protocol FRALLE 93 from june 1993 to septem ber 1998. Disease Free Survival for the all protocol is 78 % +/- 3 and over all survival 83 % +/- 3. Various clinical and laboratory features at the ti me of diagnosis have been correlated with prognosis They provide a potentia l mean to stratify patients into treatment subgroups according their relati ve fisk of treatment failure. The identification of these prognostic factor s has been an essential element in the design of current therapeutic trials Prognostic characteristics of childhood ALL include : age, white blood cel l count, tumor. burden, cytogenetics (chromosome count and chromosomal tran slocation), immunophenotype and early response to treatment. Molecular biol ogy has been the revolution of the last two decades permitting the cloning of the genes involved in the leukemic process. Finally the new molecular te chniques allow a sensitive diagnostic approach to minimal residual disease (MRD). The better detection of MRD must allow a more rational basis for the rapeutic intensification for a subset of poor responder patients. A decreas e in therapy of very good responders can also be envisaged.