Clinical Review

Acute leukaemia in children: diagnosis and management

BMJ 2009; 338 doi: (Published 11 June 2009) Cite this as: BMJ 2009;338:b2285
  1. Chris Mitchell, consultant paediatric oncologist1,
  2. Georgina Hall, consultant paediatric haematologist1,
  3. Rachel T Clarke, foundation year 1 doctor2
  1. 1Department of Paediatric Haematology/Oncology, John Radcliffe Hospital, Oxford OX3 9DU, UK
  2. 2John Radcliffe Hospital, Oxford
  1. Correspondence to: C Mitchell chris.mitchell{at}

    Summary points

    Presentation of acute leukaemia can be non-specific, and not always have the classic signs and symptoms of anaemia, bruising, bleeding, hepatosplenomegaly, and lymphadenopathy.

    Diagnosis can be difficult, and delays can contribute to additional, sometimes life threatening problems during the period of initial treatment.

    Relatively simple, inexpensive tests—a full blood count and examination of the blood film—will diagnose acute leukaemia in most cases.

    Overall survival has risen from less than 5% in the 1960s to over 85% today.

    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.

    What causes acute leukaemia?

    Acute leukaemia arises from genetic mutations in blood progenitor cells. These mutations generate both an uncontrollable capacity for self-renewal and the developmental arrest of the progenitor cells at a particular point in their differentiation.6 The body is therefore overwhelmed by immature cells …

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