Pediatric acute lymphocytic leukemia characterized

07-11-2006

Predictive factors for pediatric acute lymphocytic leukemia (ALL) were characterized.

"ALL often presents with musculoskeletal concerns such as pain or swelling, even before appearance of blasts in the peripheral blood. Such presentation may lead to misdiagnosis of a child with juvenile rheumatoid arthritis (JRA)," researchers in the United States reported.

"This study was designed to identify the predictive factors for leukemia using basic clinical and laboratory information," explained O.Y. Jones and colleagues, Children's National Medical Center. "A retrospective chart review was performed using a simple questionnaire to compare the clinical and laboratory findings present during the initial visit to a pediatric rheumatology clinic for 277 children who were ultimately diagnosed with either JRA (n=206) or ALL (n=71).

"Sensitivity and specificity analysis of a variety of parameters, both singly and in combination, was performed to identify predictive value for ALL. The majority (75%) of children with ALL did not have blasts in the peripheral blood at the time of evaluation by pediatric rheumatologists. In children presenting with unexplained musculoskeletal complaints, the 3 most important factors that predicted a diagnosis of ALL were low white blood cell count (<4 x 109/L), low-normal platelet count (150-250 x 109/L), and history of nighttime pain. In the presence of all 3, the sensitivity and specificity for a diagnosis of ALL were 100% and 85%, respectively."

The researchers concluded, "Other findings, including antinuclear antibody, rash, and objective signs of arthritis, were not helpful in differentiating between these diagnoses because they occurred at similar rates in both groups. When a child develops new-onset bone-joint complaints, the presence of subtle complete blood count changes combined with nighttime pain should lead to consideration of leukemia as the underlying cause."

Jones and colleagues published their study in Pediatrics (A multicenter case-control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis. Pediatrics, 2006;117(5):E840-E844).

For additional information, contact O.Y. Jones, Children's National Medical Center, Dept. Pediatrics Rheumatol, 111 Michigan Avenue NW, WW 3-5, Suite 300, Washington, DC 20010, USA.

Publisher contact information for the journal Pediatrics is: American Academy Pediatrics, 141 North-West Point Blvd., Elk Grove Village, IL 60007-1098, USA.

Keywords: Washington, District of Columbia, United States, Arthritis, Autoimmune Disease, Childhood Leukemia, Hematology, Juvenile Rheumatoid Arthritis, Leukemia, Musculoskeletal Pain, Pediatric, Peripheral Blood, Platelet Count, Rheumatology.

This article was prepared by Clinical Oncology Week editors from staff and other reports. Copyright 2006, Clinical Oncology Week via NewsRx.com.