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Acute lymphoblastic leukemia in children
Last reviewed: 07.07.2025
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Acute lymphoblastic leukemia is a group of clinically heterogeneous clonal malignancies of lymphocyte precursor cells that usually share distinct genetic and immunophenotypic characteristics. Secondary abnormalities in cellular differentiation and/or proliferation result in increased production and accumulation of lymphoblasts in the bone marrow and infiltration of lymph nodes and parenchymatous organs. Untreated acute lymphoblastic leukemia rapidly becomes fatal.
Epidemiology
More than 80% of all leukemias in children are of lymphoid origin, of which 80% are tumors of B-lymphocyte precursors, 1% are tumors of mature B-cells. About 15% originate from T-lymphocytes, less than 5% are of undetermined cellular origin.
Acute lymphoblastic leukemia is the most common oncological disease of childhood, accounting for about 25% of all malignant neoplasms in pediatrics. The incidence in developed countries is 30-40 cases per 1,000,000 children.
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Symptoms of Acute Lymphoblastic Leukemia
The main clinical signs of acute lymphoblastic leukemia are weakness, fever, malaise, pain in the bones and/or joints, hemorrhagic syndrome (bleeding of the oral mucosa, skin hemorrhages), and pallor. Fever is usually associated with bacterial, viral, fungal, or protozoal (less common) infection, especially in children with severe neutropenia (less than 500 neutrophils per μl). Weakness occurs as a result of anemia and intoxication.
Relapse of acute lymphoblastic leukemia
A victorious point in the treatment of acute lymphoblastic leukemia in children can be put only after a significant improvement in the results of treating relapses. Compared with the results of treating primary patients, the survival rate of children with relapses of acute lymphoblastic leukemia remains low, the 5-year survival of these patients does not exceed 35-40%. The chances of recovery directly depend on the development of new approaches in polychemotherapy, options for bone marrow transplantation, etc. There are isolated and combined, bone marrow and extramedullary (with CNS damage, testicular, with infiltration of other organs), very early (within 6 months from diagnosis), early (up to 18 months after diagnosis) and late (18 months after diagnosis) relapses.
Diagnosis of acute lymphoblastic leukemia
The diagnosis of acute lymphoblastic leukemia is made based on the patient's history, physical examination, and laboratory tests.
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Laboratory diagnostics
Complete blood count: white blood cell count may be normal, decreased, or increased; blast cells are often, although not always, detected; hyporegenerative normochromic anemia and thrombocytopenia are characteristic.
Biochemical blood test: characteristically increased LDH activity; indicators of kidney and liver function are also determined.
Myelogram: bone marrow puncture should be performed from at least two points (in children under 2 years of age, these are the heel bones or tibial tuberosities, in older children, the posterior and anterior iliac spines) to collect a sufficient amount of diagnostic material. It is advisable to collect the material under general anesthesia. It is necessary to make 8-10 smears from each point, and also collect material for immunophenotyping, cytogenetic and molecular genetic studies.
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Treatment of acute lymphoblastic leukemia
The basic principles of treating acute lymphoblastic leukemia in children were developed in the United States in the late 1960s. In fact, they have not changed to this day. Modern treatment of acute lymphoblastic leukemia consists of several main phases: induction of remission using three or more agents administered over 4-6 weeks, multi-agent consolidation (“consolidation”) of remission, and maintenance therapy, usually using antimetabolites for 2-3 years. A mandatory component is the prevention and treatment of neuroleukemia. Given the poor penetration of drugs through the blood-brain barrier, the mandatory use of specific therapy aimed at sanitizing the central nervous system was proposed back in 1965.
Prognosis for acute lymphoblastic leukemia
Each of the modern protocols for the treatment of acute lymphoblastic leukemia sets its own tasks, the solution of which merges into the general international trend for optimizing the therapy of this disease. For example, in the Italian version of the BFM - AIEOP group protocol, researchers left cranial irradiation only for children with hyperleukocytosis exceeding 100,000 cells per μl and with the T-cell variant of acute lymphoblastic leukemia, having achieved adequate control over the occurrence of neurorelapses.
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