Childhood Acute Leukemia Research Articles

The importance of targeted next-generation sequencing based genomic profiling at diagnosis of childhood acute myeloid leukemia: a single center experience

Background. The management of pediatric acute myeloid leukemia (AML) is based on the prognostic risk classification of initial leukemia. Targeted next-generation sequencing (NGS) is a reliable method used to identify recurrently mutated genes of pediatric AML and associated prognosis. Methods. In this study, we retrospectively evaluated the prognostic, and therapeutic utility of a targeted NGS panel covering twenty-five genes, in 21 children with de novo and 8 with relapsed or secondary AML. Results. Variants were detected in 44.8% of patients, and 63.2% of them were in the signaling pathway genes. The number of variants per patient and diversity increased with age. The panel results affected hematopoietic stem cell transplantation decisions, especially in core binding factor AML, and allowed the categorization of diseases according to current classifications. Panel results also pointed out predisposition to germline leukemia to the extent of the panel coverage. No targeted therapy was used based on the variants, and none of the variants were used to monitor minimal residual disease. Conclusions. Targeted NGS results, along with well-known genetic aberrations and treatment responses, can guide treatment modalities. The coverage of the routine panels should include proven mutations of childhood AML and germline leukemia predisposition genes.

Long-term effects of treatment of acute lymphoblastic leukemia in childhood on the part of the musculoskeletal system

Effective treatment of leukemia in children has improved both the five-year and long-term survival of patients. An increase in life expectancy requires an assessment of the long-term effects of treatment. The use of antitumor drugs such as mercaptopurin, methotrexate, tyrosine kinase inhibitors, as well as glucocorticosteroids often negatively affect the musculoskeletal system, including bone mineralization, which can lead to fractures, necrosis, arthropathy and other lesions of the musculoskeletal system, Side effects of anticancer drugs, glucocorticosteroids on bone tissue are especially important in childhood, when the skeleton is being formed and their long-term negative effect on the musculoskeletal system is no less important. The assessment of long-term consequences will make it possible to develop timely preventive measures. KEYWORDS: bone tissue, antitumor therapy, leukemia, long-term effects of treatment.

Clinical significance of dynamic monitoring of EVI1 gene expression in pediatric acute myeloid leukemia

ObjectiveTo investigate the clinical significance of dynamic monitoring ecotropic virus integration site-1 (EVI1) expression in childhood acute myeloid leukemia (AML).MethodsA retrospective analysis was conducted on 113 pediatric AML patients of Wuhan Children’s Hospital from 2014 to 2022. The correlation between EVI1 expression levels and clinical indicators including clinical characteristics, first complete remission (CR1), relapse, and overall survival (OS) was analyzed. Receiver operating characteristic (ROC) curve analysis was carried out to comprehend the influence of EVI1 expression on relapse.ResultsA total of 78 AML children with EVI1 expression at initial diagnosis were eligible, divided into EVI1-positive (EVI1high) and EVI1-negative (EVI1low) groups. FAB classification (P = 0.047) and abnormal karyotype (P = 0.009) showed significant differences between the two groups. The proportion of EVI1high in individuals with complex and/or monomeric karyotypes was significantly higher than in other cases (P = 0.032). When completing the first induction therapy, the EVI1high group showed a significantly lower CR1 rate than the EVI1low group (P = 0.015). Among 51 cases with EVI1 expression dynamically monitored, those with EVI1 overexpression more than twice had significantly shorter OS (P < 0.05). Among 19 non-HSCT patients undergoing three EVI1 assessments during induction therapy, those with EVI1 overexpression over once had higher relapse rates (P = 0.045). In addition, EVI1 expression level ≥ 83.38% significantly predicted relapse (AUC = 0.833).ConclusionAberrantly high expression of EVI1 in pediatric AML was associated with poor prognosis. Continuous and dynamic monitoring of EVI1 expression promotes prognostic evaluation. We add some insights into the impact of EVI1 on the AML patients’ OS and survival.

The Association between Allergies and Hematologic Tumors — A Review

Introduction: Dysfunctions of the immune system in allergic diseases and hematological malignancies are the subject of many studies due to the mechanisms that link them. Chronic inflammation created in the immune response in an allergic reaction has been associated with developing neoplastic diseases. Aim of the study: This review examines the potential correlation between Allergies and Hematologic Tumors: acute lymphoblastic leukemia, childhood leukemias, non-Hodgkin and Hodgkin lymphomas. Material and methods: An English-language literature review was conducted, analyzing studies from the PubMed database up to October 2024 regarding the correlation between Allergies and Hematologic Tumors. The review was performed using the PubMed database, with 50 works used. Conclusions: The relationship between allergies and hematological tumors is unclear. According to some studies, this relationship does not exist; some state, however, that allergic diseases show correlations with hematological malignancies. The results of these studies do not provide a clear answer to whether this is a positive or negative relationship. Some studies suggest that allergies reduce the risk of hematological malignancies, while others contradict this, suggesting that allergies may increase the risk of hematological tumors. The results of studies showing an increased risk of hematological malignancies in people suffering from allergies can be due to the hypothesis of antigenic stimulation, which may explain the mechanism of correlation between those diseases. This hypothesis suggests that chronic immune stimulation predisposes to hematologic malignancies such as multiple myeloma, non-Hodgkin's lymphoma (NHL), and leukemia by promoting the development of randomly occurring pro-oncogenic mutations in actively dividing immune cells. Different results on this potential correlation showed that further studies are necessary.

Maternal illnesses during pregnancy and the risk of childhood cancer: A medical-record based analysis (UKCCS).

Often relying on mother's recollections of past events, the possible relationship between maternal illness in pregnancy and risk of malignancy in their offspring has long been a focus of research. Free from recall bias, this study of childhood cancer (0-14 years) examined these associations using data abstracted from mothers' primary-care (1623 cases, 2521 controls) and obstetric (2721 cases, 5169 controls) records. Maternal infections and other illnesses in pregnancy were examined for any possible associations with childhood leukaemia, lymphoma, CNS or embryonal tumours using pooled information from the two medical record sources (2885 cases and 5499 controls), accounting for potential confounders. Maternal anaemia was associated with childhood acute myeloid leukaemia (AML) (odds ratio, OR = 2.07, 95%CI [1.40-3.08]). Anaemia during pregnancy was also recorded more frequently in the notes of mothers of children with medulloblastoma, retinoblastoma and embryonal rhabdomyosarcoma: ORs 2.36 [1.36-4.11], 1.83 [1.01-3.33] and 2.91 [1.64-5.16] respectively. Other associations included urinary tract infections (UTIs) and non-Hodgkin lymphoma (NHL); preeclampsia and NHL; and polyhydramnios with both AML and NHL. No evidence was found to suggest that influenza during pregnancy impacted on childhood leukaemia risk. In conclusion, our findings are supportive of an association between maternal anaemia in pregnancy and childhood AML, and maternal anaemia and embryonal tumours; underscoring the need for further research exploring the potential causes and roles of iron and vitamin deficiencies. Due to small numbers and lack of corroborative evidence, the associations observed for UTIs, preeclampsia, and polyhydramnios must be treated cautiously.

The Exportin, CSE1L, Regulates Ribosome Biogenesis and Is a Selective Dependency in Childhood and Young Adult Acute Myeloid Leukemia

The Exportin, CSE1L, Regulates Ribosome Biogenesis and Is a Selective Dependency in Childhood and Young Adult Acute Myeloid Leukemia

CD38 and CD58: A Gallant Savior in Under-Resourced Laboratories.

Background B-cell acute lymphoblastic leukemia (B-ALL) is one of the most common childhood malignancies and comprises almost the majority of acute leukemias in children. At the end of induction, minimal residual disease (MRD) is one of the most important prognostic indicators. MRD is commonly detected by multiparametric flow cytometry. Interpreting panels consisting of multiple tubes requires a lot of expertise and is subject to stringent standardization processes. Hence, there arises a need for an easier alternative that can be more universally applicable and reduce complexity in interpretation, resulting in uniform reporting and cost-effectiveness, especially in resource-deficient settings, without compromising clinical outcomes. Therefore, the aim is to find the usefulness of the MRD "lite" panel for post-induction MRD detection in pediatric B-ALL using CD38, CD10, CD34, CD19, and CD45 compared to the "standard tube" panel. Methods The study included 25 children diagnosed with B-ALL and undergoing treatment. MRD detection was performed on day 28 of post-induction chemotherapy using a standard tube panel consisting of three tubes (gold standard) and our single tube MRD "lite" panel. The results obtained by the two were compared. Results The sensitivity and specificity of the MRD "lite" panel were calculated as 100% and 84.2%, respectively, taking the standard tube panel as the gold standard. CD10, CD20, and CD200 were valuable in distinguishing MRD-positive cases from MRD-negative cases. Moreover, the MRD "lite" panel had 100% concordance between the two observers, suggesting simplicity in assessment and, hence, wider applicability.

Rapidly determine venetoclax in plasma sample using an LC-MS/MS method and apply it in TDM for acute leukemia children patient

AbstractVenetoclax is the first oral Bcl-2 inhibitor with high affinity targeting tumor cell apoptosis mechanism. In this study we developed a simple, sensitive and reliable LC–MS/MS method to determine venetoclax in children's hemolytic or lipemic samples. The method utilized an electrospray ion source and operated in multiple reaction monitoring mode. Venetoclax-d8 was used as an internal standard. Plasma samples were precipitated by acetonitrile containing 10% dimethyl sulfoxide and were separated by a Hypersil GOLD column (2.1 mm × 150 mm, 5 μm). The mobile phase consisted of acetonitrile-2 mM ammonium acetate (30:70, v/v) containing 0.4% formic acid. The quantification for venetoclax and venetoclax-d8 were m/z 868.1 → 636.1, m/z 876.1 → 644.1, respectively. The linear range was 10–2,000 ng mL−1 for venetoclax. The matrix in normal plasma, hemolytic or lipemic plasma had no significant effect on the detection results. The specificity, recovery and stability also met the acceptance criteria of guiding principles for the validation of biological sample quantitative analysis presented in the Chinese Pharmacopoeia (2015). As a result, this method is particularly suitable for determining venetoclax in hemolytic or lipemic samples from children with acute myeloid leukemia. The method, with the application of monitoring drug concentrations in pediatric patients, was successful.

Bloodstream Infections in Childhood Acute Myeloid Leukemia and Machine Learning Models: A Single-Institutional Analysis.

Childhood acute myeloid leukemia (AML) requires intensive chemotherapy, which may result in life-threatening bloodstream infections (BSIs). This study evaluated whether machine learning (ML) could predict BSI using electronic medical records. All children treated for AML at Children's Minnesota between 2005 and 2019 were included. Patients with Down syndrome AML or acute promyelocytic leukemia were excluded. Standard statistics analyzed predictors of BSI, and ML models were trained to predict BSI. Of 95 AML patients, 54.7% had BSI. Of 480 admissions, 19% included BSI. No deaths were related to BSI, and survival of non-Whites was significantly inferior to White patients. Logistic regression revealed that higher cytarabine doses increased the risk of BSI, with an odds ratio (OR) of 1.110 (P < 0.05). Prophylactic levofloxacin-vancomycin reduced the risk of BSI, with OR of 0.495 (P < 0.05). The best-performing ML model was regularized logistic regression with an area under the curve (AUC) of 0.748, improved specificity by 37.5% compared with neutropenia, and 2.6% compared with fever. In conclusion, BSI risk was increased by cytarabine and reduced by levofloxacin-vancomycin prophylaxis. ML predicted BSI with improvement over fever or neutropenia. In clinical practice, ML may offer flexibility by controlling sensitivity and specificity by adjusting BSI diagnosis thresholds.

Considerations for using tree-based machine learning to assess causation between demographic and environmental risk factors and health outcomes.

Evaluation of the heterogeneous treatment effect (HTE) allows for the assessment of the causal effect of a therapy or intervention while considering heterogeneity in individual factors within a population. Machine learning (ML) methods have previously been employed for HTE evaluation, addressing the limitations associated with modelling complex systems. In this work, three tree-based ML algorithms, causal random forest (CRF), causal Bayesian additive regression trees (CBART), and causal rule ensemble (CRE), are used to analyze the potential causation of benzene exposure to cause childhood acute myeloid leukemia (AML). Data for this analysis is generated by drawing samples from a previously developed model that estimates AML probability given as input demographic information and benzene exposure. Comparison is drawn between the three tree-based algorithms in terms of the predicted average treatment effect (ATE), the regression coefficient of determination, and the computational time of each algorithm. Minimal difference is reported between the three tree-based algorithms in terms of the ATE, as well as the regression coefficient of determination. However, CRF outperforms CBART in terms of algorithm computational time. Moreover, CRF allows for both continuous and binary treatment variables, as opposed to CBART and CRE, making it better suited to environmental health studies, where exposure levels of pollutants shall be considered continuous. Following the comparison of all three algorithms, the influence of adding Gaussian noise to the treatment and outcome variables, as well as outliers, is investigated using CRF. A set of considerations is drawn to guide researchers in using these algorithms. These considerations detail the simulation settings, applications, and results interpretation and aim to provide prompt information in decision-making surrounding the establishment of pollutant exposure thresholds in environmental risk assessments.

The role of routing in the diagnosis of acute leukemia in children: an observational retrospective non-randomized study

BACKGROUND: Acute leukemia is the commonest malignancy of childhood with an incidence rate of about 55–62 per 1 million under 18 years of age. Early diagnosis of acute leukemia is difficult due to the non-specificity of primary symptoms, which are often hidden under the “masks” of other diseases. This problem is especially relevant for regions with a population of up to 100 thousand people, where a case of acute leukemia in children occurs every 2–5 years causing too low oncological alertness among pediatricians. AIM: Assess the delay in diagnosis depending on the areas of residence in the Tver region and area remoteness from the Tver Regional Clinical Children’s Hospital (Tver, Russia). MATERIALS AND METHODS: The analysis included 35 patients hospitalized in the Department of Oncology and hematology of the Tver Regional Clinical Children’s Hospital for the period from 2018 to 2023. The diagnoses were: acute lymphocytic leukemia (C91.0) — 30 (86%) patients, acute myeloid leukemia (C92) — 3 (9%) patients, and acute leukemia of unspecified cell type (C95.0) — 2 (5%) patients. The mean age was 61 months (5.1 years). Thrombocytopenia and anemia at the time of diagnosis were found in 76% and 78%, respectively. Leukocytosis ( 20×109/L) was observed in 58%, leukopenia (3.5×109/L) in 15% of patients. In 97% of cases blasts (2% to 95%) were detected in peripheral blood. In the city of Tver (Group 1) and the Tver region (Group 2), 16 (46%) and 19 (54%) patients were identified, respectively. The mean age of patients in Group 1 is 28.6 months, and in Group 2 — 72.3 months (p=0.1). RESULTS: In Groups 1 and 2, acute lymphocytic leukemia was diagnosed in 14 (88%) and 16 (84%), respectively (p=0.6); acute myeloid leukemia — in 1 (6%) and 2 (11%), respectively (p=0.7); acute leukemia of unspecified cell type — in 1 (6%) and 1 (5%) cases, respectively (p=0.95). Delay of diagnosis in the general group (n=35) was observed as follows: 2 weeks — in 21 (60%) cases; 2–4 weeks — in 7 (20%) cases; 4–8 weeks — in 4 (11%) cases: 8 weeks — in 3 (9%) cases. Comparison of the time of delayed diagnosis among patients living in the city of Tver versus the Tver region yielded following results: 2 weeks in 7 (44%) vs 13 (68%) cases; 2–4 weeks — in 6 (38%) vs 3 (17%), 4–8 weeks — in 1 (6%) vs 1 (5%); 8 weeks — in 2 (12%) vs 2 (10%) cases, respectively (p=0.37). There was no significant impact of the distance of the residence place from the level 3 children’s hospital providing specialized care on the time of diagnosis. With the patients’ distance of 50 km from the clinic, the diagnosis delay of 2 weeks, 2–4 weeks, 4–8 weeks and 8 weeks was observed in 36%, 36%, 21% and 7% of cases, respectively. With the distance of 50–100 km, the diagnosis was made in the period of 2–4 weeks in 100% of cases. With the removal of 100 km the diagnosis delay of 2 weeks, 2–4 weeks, 4–8 weeks, 8 weeks was observed in 30%, 30%, 20% and 20%, respectively (p=0.78). CONCLUSION: The distance from the third-level hospital did not affect the period of diagnosis of acute leukemia in children. We believe this is achieved by holding daily on-line conferences with country hospitals and out-patient departments followed by the rapid hospitalization of children with suspected oncohematological disorders in the specialized department.

Glycated albumin may have a complementary role to glycated hemoglobin in glucose monitoring in childhood acute leukemia.

Glycated hemoglobin (HbA1c) as a glycemic index may have limited value in pediatric patients with acute leukemia as they often present with anemia and/or pancytopenia. To address this issue, we evaluated the usefulness of glycated albumin (GA) as a glycemic monitoring index in pediatric patients with acute leukemia. Medical records of 25 patients with type 2 diabetes mellitus (T2DM), 63 patients with acute leukemia, and 115 healthy children from Seoul St. Mary's Hospital, The Catholic University of Korea, were retrospectively investigated for serum GA, HbA1c, and fasting blood glucose (FBG) levels, along with demographic data. GA, HbA1c, and FBG levels did not differ between the control and acute leukemia groups. In the T2DM group, positive correlations were observed among GA, HbA1c, and FBG (P<0.01). Although GA level was not associated with the HbA1c level in the control group, GA and HbA1c levels showed a positive correlation in the acute leukemia group (P=0.045). Regression analysis revealed GA and HbA1c levels to be positively correlated in the acute leukemia and T2DM groups even after adjusting for age, sex, and body mass index z-score (P=0.007, P<0.01). GA may be a useful complementary parameter to HbA1c for glycemic monitoring in pediatric patients with acute leukemia, similar to its use in patients with T2DM.

Central nervous system complications during treatment in childhood acute leukemia.

Central nervous system (CNS) complications can be seen in patients with leukemia, depending on the disease itself and the chemotherapeutic agents used. This study focused on CNS complications during treatment in children with acute leukemia in a single pediatric institution. CNS complications were evaluated retrospectively in 115 patients with ALL and AML. Patients with CNS leukemia infiltration at the time of diagnosis or during a neurological event, late-onset encephalopathy, peripheral neuropathy, or a previous history of neurological abnormalities were excluded from the study. A total of 115 children's clinical records with acute leukemia over a four-year period were reviewed. Acute CNS complications developed in 23.1% of acute myeloid leukemia (AML) patients and in 13.5% of acute lymphoblastic leukemia (ALL) patients. CNS complications developed most frequently during the induction phase of the treatment (66.7%). Seizures were the most common symptom (9 patients, 50%), followed by hemiparesis (4 patients, 22.2%) and headache (4 patients, 22.2%). Six patients (33.3%) had chemotherapy-induced toxic leukoencephalopathy, two (11.1%) had Wernicke's encephalopathy, and one patient (5.6%) each had sinus vein thrombosis, posterior reversible encephalopathy syndrome, and CNS infection. Sequelae occurred in three patients (16.7%), and only one patient (5.6%) died due to a CNS complication. Awide variety of symptoms can be observed in childhood leukemia, depending on the disease itself, the chemotherapeutic agents used and a lot of other conditions such as nutritional problems. Our research shows that several CNS complications might manifest with similar symptoms; differentiated diagnosis between the underlying etiological reasons can be made by neuroimaging.

Familial Cases of Acute Leukemia in Children in Uzbekistan

Familial Cases of Acute Leukemia in Children in Uzbekistan

Long-Term Outcomes of Childhood Acute Lymphocytic Leukemia Treated with Adapted Berlin-Frankfurt-Münster (BFM) Protocols: A Multicentric Analysis from a Developing Country.

The objective of the current study was to determine the survival probabilities of children and adolescents with acute lymphocytic leukemia treated with adapted Berlin-Frankfurt-Münster (BFM) protocols and compare our results with the original BFM reports. This retrospective study included 695 patients up to 19 years old treated with adapted BFM protocols between 1997 and 2018 in four hospitals in Rio de Janeiro. The 1997-2007 and 2008-2018 cohorts were analyzed separately. More than half of the patients were stratified into the high-risk BFM classification. Overall and event-free survivals were, in the 1997-2007 period, respectively, 88% and 80% (BFM standard risk group-SRG), 75% and 67% (intermediate risk group-IRG), and 48% and 33% (high-risk group-HRG). The corresponding numbers for the 2008-2018 period were 93% and 84% (SRG), 75% and 63% (IRG), and 64% and 57% (HRG). In the second period, both the OS (HR = 0.71, p = 0.011) and EFS (HR = 0.62, p < 0.001) were higher. Except for the intermediate-risk group, the latter results are comparable to the BFM. The BFM protocol adaptations can be safely implemented in developing countries, accounting for local specificities.

Cost-effectiveness of treating childhood acute myeloid leukemia at a tertiary care center in North India.

Childhood cancers are a significant global health concern, particularly in low- and middle-income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost-effectiveness of childhood AML treatment in India and other LMICs remain limited. The study focused on children (<15years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment-related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost-effectiveness was assessed using disability-adjusted life years (DALY) averted in relation to the country-specific cost-effectiveness threshold. Among 59 AML patients, treatment-related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis-related complications, with treatment-related mortality reaching 30%. The 3-year event-free survival and overall survival of the 43 patients who received intensive therapy were 24.5%±7.6% and 27.9%±8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost-effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost-effective with a stringent cost-effectiveness threshold utilized. The study underscores the challenges faced while treating childhood AML in LMICs, including treatment-induced high sepsis-related mortality and abandonment. Despite these challenges, it remains cost-effective to treat childhood AML in India. Future efforts should focus on reducing treatment-related morbidity and mortality to further improve outcomes and cost-effectiveness.

National study reveals gram negative bacteremia on contemporary pediatric AML protocol

Since bacteremia complicates childhood Acute myeloid leukemia (AML) patients, we assessed bacteremia rates in Israeli children with de-novo AML. All chemotherapy courses of patients enrolled in NOPHO-DBH-2012 AML protocol were included. Down syndrome, acute promyelocytic leukemia were excluded. Among 69 patients, seven had focal bacterial infections. Of the remaining 62, 77.4% had 1–8 bacteremias. Of 238 chemotherapy courses, 98 (41.2%) had bacteremia: 66 (67.3%) predominantly Gram-negative rods (GNR); 28 (28.6%) Gram-positive cocci. Escherichia coli; followed by Klebsiella were most common. Older age, Arab ethnicity, and presenting white blood cell count were associated with an increased risk of bacteremia in the univariable analysis, but these associations were not confirmed in the multivariable analysis. Mortality was high (9.7%), and bacteremia increased PICU utilization 7-fold half from GNR. Most isolates were sensitive to vancomycin/meropenem (94.7%), but GNR had low sensitivity to quinolones (61.8%). High mortality and morbidity of de-novo AML patients from predominantly GNR bacteremia require specific interventions but limited susceptibility to quinolones hampers prophylaxis.

Long-term survival outcome of childhood acute myeloid leukemia: a 43-year experience in Thailand, a resource-limited country

Although there have been advances in treating pediatric patients with acute myeloid leukemia (AML) in developed countries, outcomes in low- to middle-income countries remain poor. The goal of this study was to investigate the outcomes in children with AML who were treated at a tertiary care center in Thailand. We divided the study into 4 research periods based on the chemotherapy protocols employed. The 5-year probabilities of event-free survival (pEFS) rates for periods 1–4 were 19.0%, 20.6%, 17.4%, and 37.3% (p value = 0.32), while the 5-year probabilities of overall survival (pOS) rates were 19.0%, 24.7%, 18.7%, and 42.5% (p value = 0.18), respectively. The multivariable model indicated an improvement in 5-year pOS between periods 1 and 4 (p value = 0.04). Age, white blood cell count, and study period were significant predictors of survival outcomes. The pOS of AML patients improved over time, increasing from 19.0% to 42.5%.

Current situation and prospect of diagnosis and therapy of childhood acute leukemia in China

Acute leukemia is the most common hematopoietic stem cell malignant tumor in children, which ranks in the top one of the incidence of tumor in children, it is a major disease that affects the growth and survival of children. With the continuous improvement of medical diagnosis and treatment and the extensive development of immunotherapy, the survival rate and quality of life of children with acute leukemia have been significantly improved. In recent years, three cooperative groups of childhood leukemia have been established in China, and a series of high-level research results have been published. In the future, efforts should be made to promote the process of standardization and homogenization in the diagnosis and treatment of children's acute leukemia, explore the monitoring targets of sensitive residual diseases, and find the best treatment for refractory/recurrent cases. Speeding up the clinical research of new drugs will be an urgent problem and development direction in the field of acute leukemia diagnosis and treatment in children.

Review of Leukemia in Children

Leukemia is the most common cancer in children, accounting for approximately one-third of all pediatric cancers. This disease affects the blood-forming tissues, with leukemic cells first growing in the bone marrow, then entering the peripheral blood, and possibly spreading to various organs, including the skin. Acute leukemia’s clinical symptoms stem from the frequently rapid onset of bone marrow failure. The clinical presentation typically includes high fever, gastrointestinal and pulmonary symptoms, severe and worsening anorexia, muscle and joint pain, and bleeding. This review explores the incidence and general epidemiology of childhood leukemia, including risk-increasing syndromes; recognizes the clinical presentation and interpretation of blood counts; examines potential oncologic emergencies; describes prognostic factors and the importance of minimal residual disease in precursor B-lymphoblastic leukemia; highlights supportive care in treating acute myelogenous leukemia; and addresses long-term complications of modern childhood leukemia treatments. This narrative review discusses the evidence suggesting an in-utero origin of childhood acute leukemia, focusing on acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). It highlights the significant diagnostic presence of these acute leukemias among hematologic cancers, the investigations into prenatal leukemogenesis, and the literature on prenatal risk factors during gestation.