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Clinical presentation of childhood leukaemia: a systematic review and meta-analysis
Rachel T Clarke1, Ann Van den Bruel1, Clare Bankhead1
1Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
Childhood leukaemia often presents with key signs like enlarged liver or spleen, pallor, fever, and bruising. Early detection in children requires awareness of these common symptoms and a thorough clinical examination.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Medicine
Background:
- Leukaemia is the most common childhood cancer, representing one-third of all pediatric cancer cases.
- Early detection of childhood leukaemia is crucial for improving patient outcomes.
- Understanding the common clinical presentations aids in timely diagnosis.
Purpose of the Study:
- To systematically review existing data on the clinical presentation of childhood leukaemia.
- To estimate the frequency of signs and symptoms at or prior to diagnosis.
- To assist clinicians in the early detection of paediatric leukaemia.
Main Methods:
- Comprehensive search of MEDLINE and EMBASE databases.
- Inclusion of studies on leukaemia presentation in children aged 0-18 years, without date or language restrictions.
- Meta-analysis of data from 33 cohort studies involving 3084 children.
Main Results:
- Identified 95 presenting signs and symptoms, ranked by frequency.
- Hepatomegaly (64%), splenomegaly (61%), pallor (54%), fever (53%), and bruising (52%) were present in over 50% of cases.
- Other common symptoms included recurrent infections, fatigue, limb pain, and bleeding tendencies; 6% of children were asymptomatic.
Conclusions:
- Over half of children with leukaemia exhibit hepatomegaly, splenomegaly, pallor, fever, or bruising at diagnosis.
- Abdominal and musculoskeletal symptoms are frequent, necessitating a focused clinical examination.
- Multiple unexplained symptoms in children should prompt consideration of leukaemia.
Objective:
Leukaemia is the most common cancer of childhood, accounting for a third of cases. In order to assist clinicians in its early detection, we systematically reviewed all existing data on its clinical presentation and estimated the frequency of signs and symptoms presenting at or prior to diagnosis.
Design:
We searched MEDLINE and EMBASE for all studies describing presenting features of leukaemia in children (0-18 years) without date or language restriction, and, when appropriate, meta-analysed data from the included studies.
Results:
We screened 12 303 abstracts for eligibility and included 33 studies (n=3084) in the analysis. All were cohort studies without control groups. 95 presenting signs and symptoms were identified and ranked according to frequency. Five features were present in >50% of children: hepatomegaly (64%), splenomegaly (61%), pallor (54%), fever (53%) and bruising (52%). An additional eight features were present in a third to a half of children: recurrent infections (49%), fatigue (46%), limb pain (43%), hepatosplenomegaly (42%), bruising/petechiae (42%), lymphadenopathy (41%), bleeding tendency (38%) and rash (35%). 6% of children were asymptomatic on diagnosis.
Conclusions:
Over 50% of children with leukaemia have palpable livers, palpable spleens, pallor, fever or bruising on diagnosis. Abdominal symptoms such as anorexia, weight loss, abdominal pain and abdominal distension are common. Musculoskeletal symptoms such as limp and joint pain also feature prominently. Children with unexplained illness require a thorough history and focused clinical examination, which should include abdominal palpation, palpation for lymphadenopathy and careful scrutiny of the skin. Occurrence of multiple symptoms and signs should alert clinicians to possible leukaemia.
