Acute leukaemia is the commonest malignancy of childhood. In the United Kingdom, one in 2000 children develop the disorder, with around 450 new cases being diagnosed annually.1 However, most general practitioners will see a case of childhood leukaemia only once or twice in their careers2 and, since management generally takes place in tertiary referral centres, non-specialist paediatricians will encounter relatively few patients.

Compared with the 1970s, the outcome today for children with acute leukaemia has improved dramatically. Numerous high quality randomised controlled trials have shown that over 85% of children can now be cured.3 4 Goals for the future should focus on keeping treatment and side effects to a minimum for patients at low risk of recurrent disease, and improving the outcome for the small proportion of children at high risk of relapse.5

In this review, we summarise current knowledge about the presentation, diagnosis, and optimum management of children with acute leukaemia. We also suggest strategies for early diagnosis of the disease in primary care, which should minimise avoidable complications and allow for early supportive care.