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KMID : 0367419740150010010
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Journal of Korean Pediatric Society
1974 Volume.15 No. 1 p.10 ~ p.22
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Clinical Studies on Leukemia in Childhood
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洪彰義/Hong, Chang Yee
金相祐/Kim, Sang Woo
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Abstract
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One hundred and eighty-six cases of leukemia in children, aged 0~14 years, who admitted Seoul National University Hospital for 15 years from Jan. 1957 to Dec. 1971, were analysed.
The incidence of childhood leukemia was about 0.3% among the total patients who visited the hospital during the same period. There were 138 boys and 48 girls (sex ratio, 2.9:1). 39.2% of the cases occured in the age group of 0 to 4 years, 35.5% in the 5 to 9 years, and 25.3% in the 10 to 14 years with a peak incidence at 4 years of age.
The incidence of the various cytological types of leukemia was as follows: acute lymphocytic:41.9%, acute myelocytic: 30.1%, acute monocytic: 3.2%, erythroleukemia: 1.6%, chloroma: 0.6%, unclassified acute leukemia: 17.8% and chronic myelocytic leukemia: 4.9%. Most of the leukemias were acute form(95%) and high incidence of acute lymphocytic leukemia was noted under 5 years of age.
Common chiek complaints were pallor (44%), fever (33%), hemorrhage or purpura (29%), lassitude (20%), bone or joint pain (12%) in acute form abdominal mass or distension in chronic form. Liver was palpated over one finger breath in 80% and spleen was palpated in 48% of the cases.
Exophthalmos was a prominent sign in 11 cases out of 160 cases, seen since 1960. 7 cases were acute myelocytic leukemia, 3 cases acute lymphocytic and one chloroma. In 5 cases exophthalmos was the presenting complaints.
Meningeal leukemia occured in 11 cases. There were 6 cases of acute lymphocytic leukemia and 3 cases of acute myelocytic, one of erythroleukemia and one of unclassified leukemia. Cell count in CSF was average 837/mm(^3) (range: 11~5,000). The sugar and protein content was variable.
Mediastinal mass was prominent sign in 6 cases. Because of dyspnea, cough and puffy face, other conditions (acute nephritis, heart failure) were suspected before blood examination.
Hemoglobin value below 6 g/100ml was found in 94 cases (52%), 6~9g/100ml in 58 cases(31%), 9~12g/100ml in 24 cases (13%) and above 12g/100ml was only in 6 case (4%).
Leukocytosis was noted in two third of cases (67%), marked leukocytosis (above 50,000/mm(^3)) in 24% of the cases. In 16% of the cases, WBC count was below 5,000/mm(^3).
In most of the cases, platelets were decreased in number and it related closely to skin purpura and bleeding tendency of mucous membrane; in 49% of the cases platelet counts were below 50,000/mm(^3), in 45% between 50,000 and 150,000/mm(^3), and in only 6% they were above 150,000/mm(^3).
L-Asparaginase was tried alone in 15 cases (7 in ALL, 8 in AML) for inducing remission. In acute lymphocytic leukemia, 4cases ous of 7 showed complete remission while in acute myelocytic leukemia olny one case showed complete remission.
In epidemiological survey there were several area where relative high incidence of leukemia was suggested, but no common causative factors were recognized.
A review of literature on the leukemia in childhood was made.
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