Systemic paediatrics: acute lymphoblastic leukaemia prognosis: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Systemic paediatrics: acute lymphoblastic leukaemia prognosis

Sample item

A 4-year-old with B-cell acute lymphoblastic leukaemia has a presenting WBC of 20,000 and a t(12;21) translocation. What does this indicate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. A favourable prognosis

Age between 1 and 10 years, a low initial WBC, hyperdiploidy and t(12;21) (ETV6-RUNX1) are favourable features. The Philadelphia chromosome t(9;22) and infant leukaemia with KMT2A rearrangement carry a poor prognosis.

Option by option

  • A. A favourable prognosis (correct)

    Correct. ETV6-RUNX1 with young age and low WBC is favourable.

  • B. The need for upfront transplantation

    Upfront transplantation is reserved for very high-risk disease.

  • C. An unfavourable prognosis

    Poor prognosis is seen with t(9;22) or infant leukaemia.

  • D. T-cell lineage

    This translocation occurs in B-lineage disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, A favourable prognosis. Age between 1 and 10 years, a low initial WBC, hyperdiploidy and t(12;21) (ETV6-RUNX1) are favourable features.

Why is "The need for upfront transplantation" not the answer?

Upfront transplantation is reserved for very high-risk disease.

Why is "An unfavourable prognosis" not the answer?

Poor prognosis is seen with t(9;22) or infant leukaemia.

Why is "T-cell lineage" not the answer?

This translocation occurs in B-lineage disease.

What concept does this question test?

It tests Systemic paediatrics: acute lymphoblastic leukaemia prognosis in Pediatrics. The Philadelphia chromosome t(9;22) and infant leukaemia with KMT2A rearrangement carry a poor prognosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic paediatrics: acute lymphoblastic leukaemia prognosis?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.