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Children’s Oncology Group (COG) risk groups
Source: Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 21, 2025 · Captured 2026-09-09.
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Context: Risk-Based Treatment Assignment / Prognostic (Risk) Groups
In COG protocols, children with ALL are initially stratified into treatment groups (with varying degrees of risk of treatment failure) on the basis of a subset of prognostic factors, including the following:
Age.
WBC count at diagnosis.
Immunophenotype.
Cytogenetics/genomic alterations.
Presence of extramedullary disease.
Down syndrome.
Steroid pretreatment.
EFS rates exceed 85% in children meeting good-risk criteria (aged 1 to <10 years, WBC count <50,000/μL, and precursor B-cell immunophenotype). In children meeting high-risk criteria, EFS rates are approximately 75%.[4,57,148,160,161] Additional factors, including cytogenetic abnormalities and measures of early response to therapy (e.g., MRD levels in peripheral blood on day 8 and in bone marrow samples at the EOI), considered in conjunction with presenting age, WBC count, immunophenotype, the presence of extramedullary disease, and steroid pretreatment can identify patient groups for postinduction therapy with expected EFS rates ranging from less than 40% to more than 95%.[4,133]
Patients who are at very high risk of treatment failure include the following:[162-165]
Infants with KMT2A rearrangements.
Patients with hypodiploidy (<44 chromosomes).
Patients with initial induction failure.
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Preserved source evidence · Not medical advice