Childhood leukaemia

As a group, acute leukaemias are the most common childhood malignancies, and continue to be an important cause of non-accident related childhood mortality. Fortunately, with modern chemotherapy the majority of children and young people with leukaemia can be cured. However, this treatment comes with a significant burden for our young patients and their families. Here, we review the essential and differential diagnostics and the initial management of children with suspected leukaemia, as relevant for secondary paediatric care. We will give a short overview of current treatment protocols for childhood acute lymphoblastic and acute myeloid leukaemia. We will explain how stratification according to certain prognostic factors – most importantly response to therapy – guides treatment intensity. Using modern molecular techniques for minimal residual disease monitoring and molecular disease classification, it is increasingly possible to identify patients with a cure rate well above 90% in whom a reduction in treatment intensity may seem feasible. In addition, these techniques also allow the definition of poor-risk patients who may benefit from more intensive chemotherapy and bone-marrow transplantation. Finally, we discuss long-term follow-up of survivors of childhood leukaemia as a multidisciplinary paediatric team approach, as well as the challenges of transition into adult care.