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Overview of the presentation and diagnosis of acute lymphoblastic leukemia in children and adolescents

Terzah M Horton, MD, PhD
C Philip Steuber, MD
Section Editor
Julie R Park, MD
Deputy Editor
Alan G Rosmarin, MD


Acute leukemia, the most common form of cancer in children, comprises approximately 30 percent of all childhood malignancies, with acute lymphoblastic leukemia (ALL) being five times more common than acute myeloid leukemia (AML) [1]. Each year in the United States approximately 2500 to 3500 new cases of ALL are diagnosed in children. ALL incidence is slightly higher in Whites (36 cases/million) and Hispanics (41 cases/million) than in Black Americans (15 cases/million) [2].

Survival rates for ALL have improved dramatically since the 1980s, with a current five-year overall survival rate estimated at greater than 85 percent [1,3,4]. This improvement is in large part because of treatment of large numbers of children with sequential collaborative standardized research protocols [5]. Approximately 75 to 80 percent of children with newly diagnosed ALL participate in clinical research trials, the goals of which are to improve clinical outcome and to minimize acute toxicities and late-occurring adverse events.

The presentation and diagnosis of ALL in children are reviewed here. The risk group stratification and treatment of childhood ALL are discussed separately. (See "Risk group stratification and prognosis for acute lymphoblastic leukemia in children and adolescents" and "Overview of the treatment of acute lymphoblastic leukemia in children and adolescents".)


As mentioned above, approximately 2500 to 3500 new cases of ALL are diagnosed in children each year in the United States with an incidence of approximately 3.4 cases per 100,000 [1]. The incidence of pediatric leukemia varies worldwide but this may be influenced, in part, by diagnostic and reporting differences [6]. ALL incidence is slightly higher in Whites (36 cases/million) and Hispanics (41 cases/million) than in Black Americans (15 cases/million) [2].

It appears the incidence of childhood leukemia is increasing as demonstrated by the two following studies:


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Literature review current through: Jul 2017. | This topic last updated: Jul 10, 2017.
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