Symptoms of childhood acute lymphoblastic leukemia: red flags to recognize leukemia in daily practice

Klin Padiatr. 2009 Nov-Dec;221(6):369-73. doi: 10.1055/s-0029-1239538. Epub 2009 Nov 4.


Background: The aim of this study is to identify clinical "red flags" that may assist the general pediatrician in detecting patients with an acute lymphoblastic leukemia (ALL).

Patients and methods: Medical history and clinical findings of 189 children and adolescents, diagnosed with ALL between 1/1995 and 7/2004, were analyzed retrospectively.

Results: Only 50% of patients presented with symptoms known in children with leukemia (fever, fatigue, paleness, hemorrhage); 5% were diagnosed accidentally in the absence of any clinical symptoms. The majority of patients had a medical history up to few weeks; in 11% of patients up to several months without impairing curability. 95% of the patients presented at diagnosis with enlargement of lymphnodes, liver and/or spleen. The characteristic laboratory constellation included mono-, respectively bi- or trilinear pathology of the blood count and with blasts in the blood smear.

Conclusion: The clinical diagnosis of ALL relies on physical examination and the blood count including microscopic examination. Therefore, the alertness of the treating paediatrician with regard to clinical findings and a pathologic blood count is more important than elaborate laboratory investigations. In uncertain cases, a close follow-up examination may help to unmask ALL, which will most likely be stratified in the low-risk-group.

MeSH terms

  • Adolescent
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use
  • Blast Crisis
  • Bone Marrow / pathology
  • Child
  • Child, Preschool
  • Core Binding Factor Alpha 2 Subunit / genetics
  • Delayed Diagnosis
  • Disease-Free Survival
  • Female
  • Gene Expression Regulation, Leukemic / genetics
  • Germany
  • Hemoglobinometry
  • Hepatomegaly / diagnosis
  • Humans
  • Immunophenotyping
  • Incidental Findings
  • Infant
  • Leukocyte Count
  • Lymph Nodes / pathology
  • Lymphatic Diseases / diagnosis
  • Male
  • Oncogene Proteins, Fusion / genetics
  • Pediatrics
  • Physical Examination
  • Platelet Count
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / diagnosis*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / mortality
  • Retrospective Studies
  • Splenomegaly / diagnosis


  • Antineoplastic Agents
  • Core Binding Factor Alpha 2 Subunit
  • Oncogene Proteins, Fusion
  • TEL-AML1 fusion protein