A timely diagnosis results in higher probability for improved outcomes and decreased requirements for intensive treatment.5 For example, younger children with B-cell precursor ALL diagnosed prior to the development of high leukocyte counts can be treated with less intense regimens than those with high counts.5
ALL, a disease of unknown aetiology, is defined by an abnormal white blood cell proliferation primarily in the bone marrow but also in the peripheral blood, reticuloendothelial system and other body tissues.8 Childhood ALL originates in the T- and B- lymphoblasts in the bone marrow. Most individuals with acute leukaemia present with greater than 25% blast cells in their bone marrow.9
Some factors associated with an increased risk of developing ALL include:9
- prenatal exposure to x-rays
- postnatal exposure to high doses of radiation
- Down syndrome and other genetic conditions
- Inherited genetic polymorphisms.
Many presenting signs and symptoms of ALL in a child are manifestations of anaemia, thrombocytopenia, neutropaenia, and indicate a failure of normal haematopoiesis.5 Signs and symptoms may include:5
- febrile illness
- bleeding (petechiae, purpura)
- bone pain
- respiratory distress
- testicular enlargement
- central nervous system (CNS) manifestations (e.g. headaches, irritability).
Often, on presentation, the child may not appear acutely ill.10 The duration of such symptoms varies with each child from days to months. Some children may present with conditions requiring emergent management, such as a mediastinal mass, or tumour lysis syndrome.11
The rarity of this disease, along with the fact many childhood cancers present with symptoms similar to those of common childhood diseases, can create delays and difficulties in diagnosis.
Outline proposed risk factors associated with development of childhood ALL.
Access the National Cancer Institute - Childhood Acute Lymphoblastic Leukaemia Treatment PDQ9 or an evidence based text. Explain the pathophysiology of common presenting symptoms of ALL in children.
Discuss the possible impact of a delayed diagnosis of ALL in a child from the parent's perspective.