Leukaemia is a cancer of immature precursor cells in the bone marrow, leading to unregulated proliferation of a specific type of immature blood cell (e.g., lymphoblasts).
Excessive production of a single cell type can suppress other cell lines, leading to underproduction of different cell types. This can result in pancytopenia, with a combination of:
- Low red blood cells (anaemia)
- Low white blood cells (leukopenia)
- Low platelets (thrombocytopenia)
Types of Leukaemia
The types of leukaemia that affect children from most to least common are:
- Acute lymphoblastic leukaemia (ALL) (peaks at age 2-3 years)
- Acute myeloid leukaemia (AML)
- Chronic myeloid leukaemia (CML) (rare)
Down syndrome is a key risk factor for acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML).
Presentation
The presentation of leukaemia is relatively non-specific. Potential presenting features include:
- Fatigue
- Fever
- Failure to thrive
- Persistent infections
- Bone pain
- Pallor (due to anaemia)
- Petechiae or bruising (due to thrombocytopenia)
- Abnormal bleeding
- Lymphadenopathy
- Hepatosplenomegaly
Diagnosis
The NICE guidelines (updated 2026) recommend referring for immediate specialist assessment in children with:
- Unexplained petechiae
- Hepatosplenomegaly
For the other signs and symptoms listed above, NICE recommend a full blood count within 48 hours.
Investigations to establish the diagnosis include:
- Full blood count
- Blood film
- Bone marrow biopsy
- Lumbar puncture (for CNS involvement)
Management
A paediatric oncology multi-disciplinary team will coordinate the treatment of leukaemia. Leukaemia is primarily treated with chemotherapy. Haematopoietic stem cell transplant is another key treatment.
Treatment is successful in achieving long-term remission in most children with ALL.
Chemotherapy complications include:
- Tumour lysis syndrome
- Neutropenic sepsis
- Stunted growth and development
- Neurotoxicity
- Cardiotoxicity
- Infertility
- Secondary malignancy
Last updated March 2026
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