From the Guidelines
Leukemia in pediatric patients often presents with nonspecific symptoms, including fatigue, fever, night sweats, weight loss, easy bruising or bleeding, and pain in the extremities or joints, which can be similar to those of other common childhood illnesses. These symptoms occur due to the abnormal production of blood cells in the bone marrow, leading to a reduced ability to fight infections, easy bruising, and fatigue 1. The clinical manifestations of leukemia in children can vary, but common signs include lymphadenopathy, splenomegaly, and/or hepatomegaly, which may be found in approximately 20% of patients 1.
Key Symptoms
- Persistent fatigue
- Frequent infections
- Easy bruising or bleeding
- Unexplained bleeding
- Bone or joint pain
- Swollen lymph nodes
- Abdominal swelling
- Pale skin
- Fever without an obvious cause
- Night sweats
- Weight loss
Early detection is crucial for effective treatment, and any child showing persistent symptoms should be evaluated by a healthcare provider promptly. Blood tests, including a complete blood count, are typically the first step in diagnosis if leukemia is suspected 1. The diagnosis of leukemia generally requires demonstration of 20% or greater bone marrow lymphoblasts on hematopathology review of bone marrow aspirate and biopsy materials 1.
Diagnosis and Treatment
- Blood tests, including complete blood count
- Bone marrow aspirate and biopsy
- Hematopathology evaluations, including morphologic examination and immunophenotyping
- Assessment of cytogenetic or molecular abnormalities
It is essential to note that some children may have a higher risk of developing leukemia due to genetic predisposition syndromes, such as Li-Fraumeni syndrome (LFS) 1. In these cases, the leukemias occurring in affected children tend to be low-hypodiploid acute lymphoblastic leukemia (ALL), most commonly of B-cell origin 1. Genetic counseling and consideration of testing for LFS may be necessary in cases of low-hypodiploid ALL, as the result may influence therapeutic decision making and donor choice.
From the Research
Clinical Manifestations of Leukemia in Pediatric Patients
The clinical manifestations of leukemia in pediatric patients can be diverse and varied. According to 2, the most common presenting features of leukemia in children include:
- Hepatomegaly (64%)
- Splenomegaly (61%)
- Pallor (54%)
- Fever (53%)
- Bruising (52%) Additional features that are present in a third to a half of children include:
- Recurrent infections (49%)
- Fatigue (46%)
- Limb pain (43%)
- Hepatosplenomegaly (42%)
- Bruising/petechiae (42%)
- Lymphadenopathy (41%)
- Bleeding tendency (38%)
- Rash (35%)
Abdominal and Musculoskeletal Symptoms
Abdominal symptoms such as anorexia, weight loss, abdominal pain, and abdominal distension are common in pediatric patients with leukemia 2. Musculoskeletal symptoms such as limp and joint pain also feature prominently 2.
Life-Threatening Complications
Pediatric patients with suspected leukemia are at risk of life-threatening complications, including sepsis, tumor lysis syndrome, mediastinal masses, bleeding, and pain 3.
Subtypes of Leukemia
There are two main subtypes of leukemia in children: acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) 4. A small proportion of children may have chronic myeloid leukemia (CML) or juvenile myelomonocytic leukemia (JMML) 4.
Clinical Presentation of Infant Leukemia
Infant leukemia is a rare and distinct subgroup of pediatric acute leukemias, characterized by unique and aggressive biology 5. The clinical presentation of infant leukemia can be challenging to diagnose and treat, with high-risk molecular features and high rates of chemotherapy resistance 5.