Childhood Leukemias - book cover

Presenting Features of ALL

Reprinted from Childhood Leukemias with permission from Cambridge University Press; edited by St. Jude pediatric oncologist, Ching-Hon Pui, MD.

Childhood acute lymphoblastic leukemia (ALL) has served as a model for cancer treatment for over four decades. With more precise diagnostic criteria and risk classifications, more effective therapy administered in controlled clinical trials, and better supportive care, the outlook for children with ALL has improved dramatically.   The presenting symptoms and signs of ALL are quite variable. Most cases have an acute onset, while in others the initial signs and symptoms appear insidiously and persist for months. The presenting features generally reflect the degree of bone marrow failure and extent of extramedullary spread.


Presenting clinical and laboratory features of 2209 children with newly diagnosed ALL treated consecutively at St. Jude Children's Research Hospital (1962 - 1996)
  Age (yr)  
  < 1 2
  2-9 73
  >10 25
  Male 56
  Black race 15
  Fever 53
  Fatigue 50
  Bone or joint pain 40
  Bleeding 38
  Anorexia 19
  Abdominal pain 10
  Liver edge below costal margin  
  1-4 cm 39
  5 cm 32
  Spleen edge below costal margin  
  1-4 cm 29
  5 cm 32
  Mediastinal mass 10
  Central nevous system leukemia 5
  Leukocyte count (x109/L)b  
  <10 45
  10-24 20
  25-49 12
  50-99 9
  100 14
  Hemoglobin (g/dL)c  
  <8 52
  8-10 26
  >10   22
  Platelet count (x109/L)d  
  <10 9
  10-49 39
  50-100 20
  >100 32
  a Based on 500 patients.  
  b Median (range), 12.1 (0.3-1512).  
  c Median (range), 7.8 (1.4 - 17.6)  
  d Median (range), 53 (1-1400)  


A definitive diagnosis of ALL rests with examination of the bone marrow, which is usually replaced by leukemic lymphoblasts. The identification of reliable prognostic factors in ALL and its recognition as a heterogeneous disease have led to the use of risk-directed therapy. Treatment is the single most important prognostic factor. Indeed, many other variables have emerged as useful prognostic indicators, only to disappear as treatment has improved.


Childhood Leukemias is available in the libraries of most medical schools and from major book sellers.

Ching-Hon Pui, M.D.
St. Jude Children's Research Hospital
Publisher: Cambridge University Press
ISBN: 0521581761