Initial presentation and management of acute leukemia in children

Abstract

Introduction: In addition to contemporary chemotherapy protocols and improved supportive treatment, adequate recognition of the disease and timely management contribute to the excellent outcome of acute leukemia (AL) treatment in children.

Methods: In order to determine the initial presentation of pediatric AL and the time elapsed from hospitalization to differential diagnostics and the therapy onset, a retrospective study was conducted at the Children’s Hospital Zagreb, in children with newly diagnosed acute lymphoblastic (ALL) and acute myeloid leukemia (AML) in the period 2017-2021. Demographic and clinical data, along with laboratory findings were collected. The dates of admission, hematological work-up, and the start of chemotherapy were recorded.

Results: Thirty-two children were diagnosed with AL (53 % females, median age 4.5 years), of which 81 % had ALL (54 % girls, median age 4) and 6 patients had AML (50 % females, median age 10). The most common symptoms of AL were pallor (66 %), weakness and fatigue (56 %), and skin/mucosal bleeding (50 %), which was also the predominant clinical sign along with organomegaly. The prevailing laboratory abnormality was anemia (88 %), and pancytopenia was present in a quarter (median hemoglobin 76 g/L, platelets 81.5 x 10⁹/L, leukocytes 6.73 x 10⁹/L). The average time to differential diagnostics was 2 days (for ALL and AML), with an additional 1 day for ALL and 2 days for AML until treatment initiation.

Conclusions: The initial clinical presentation of AL in children, although nonspecific, in combination with characteristic laboratory abnormalities, raises suspicion of a hematological malignancy early in experienced clinicians, which contributes to the timely initiation of the diagnostic-therapeutic procedure.