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Research
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) | |
| FEATURE | % OF TOTAL |
| Age (yr) | |
| < 1 | 2 |
| 2-9 | 73 |
| >10 | 25 |
| Male | 56 |
| Black race | 15 |
| Symptomsa | |
| 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
