Signs and symptoms at presentation

  • Persistent fatigue

  • Bone pain

  • Unexplained pyrexia and infections

  • Night sweats

  • Weight loss

  • Unexplained bruising, petechiae, bleeding

Leukaemia accounts for 31% of all childhood cancers. Symptoms at presentation can include pallor, exhaustion, unexplained bruising and bone pain. These children need an urgent full blood count or immediate admission if unwell.

Acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is an overproduction of lymphoblasts which infiltrate the bone marrow inhibiting normal cells functioning. The types of ALL are classified according to the type of lymphoid cell affected and stage of development.

The two main subtypes are:

  • B-cell (87% of cases)

  • T-Cell (13% of cases)

ALL accounts for almost 80% of all childhood leukaemia with around 400 new cases every year in the UK. It has a peak in incidence of 2-3 years of age. Boys have a greater risk than girls of developing ALL, by a factor of 4: 3 Stem cell transplantation is generally reserved for high risk groups and those who have relapsed early on in treatment.

Treatment is divided into:

  • Remission induction: most of the leukaemic cells are destroyed

  • Consolidation (intensification): further blocks of treatment to eradicate any minimal residual disease (MRD).

  • Maintenance therapy: to prevent relapse. Total duration of treatment is 2 years for girls and 3 years for boys (due to poorer survival rates).  This stage of treatment is often carried out on an outpatient shared care basis.

Survival rates are approaching 90% for common ALL, but cure rates depend on the age and sex of the child and diagnosis. The best survival rates are for children aged 1-4 years at diagnosis.

 

Acute myeloid leukaemia (AML)

AML is caused by an overproduction of myeloblasts and accounts for 15% of childhood leukaemia.

Around 70 children are diagnosed with AML every year in the UK. The treatment for AML is shorter and more intensive than for ALL. The total duration of treatment is around 6 months and children will usually be admitted to hospital for the full duration of their treatment.

A high proportion of children with AML will achieve remission but up to a quarter of these children will relapse (usually in the three years following treatment).

AML has a less positive outlook than ALL with 5 year survival in the region of 65%.

 

Chronic myeloid leukaemia (CML)

 CML is very rare in children, but if it occurs, the only curative option is stem cell transplant