Childhood leukemia outcomes similar in patients with, without musculoskeletal disease
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Childhood leukemia survival outcomes in patients with musculoskeletal involvement are similar to those among patients without musculoskeletal disease, according to data published in Pediatric Rheumatology.
“Childhood leukemia with [musculoskeletal (MSK)] involvement can mimic rheumatic or orthopedic conditions and lead to delayed diagnosis of leukemia,” Sirinthip Kittivisuit, MD, of Prince of Songkla University, in Thailand, and co-authors wrote. “To date there is no consensus on the prognostic significance of MSK involvement in childhood leukemia.”
To examine the characteristics, at first presentation, of childhood leukemia with musculoskeletal involvement, and compare survival outcomes between those with and without musculoskeletal involvement, Kittivisuit and colleagues reviewed medical records of patients aged younger than 15 years who received an acute leukemia diagnosis between January 1978 and December 2019. Included patients were treated at the oncology clinic in the department of pediatrics at the Prince of Songkla University.
Collected patient information included demographic characteristics, clinical details at the time of diagnosis, initial laboratory reports, year of diagnosis and leukemia subtype. Researchers reviewed the musculoskeletal symptoms of each patient, with involvement identified as bone and/or joint pain in terms of arthralgia or arthritis. Researchers defined arthralgia as “pain localized in one more joints,” and arthritis as “joint pain with signs of joint inflammation.”
Joint involvement patterns were identified as monoarticular, oligoarticular and polyarticular. Additionally, initial radiographs were reviewed for radiographic bone changes.
The analysis included 1,042 participants with childhood leukemia. In all, 81 — or 7.8% — of these patients demonstrated musculoskeletal involvement at initial presentation. According to the researchers, there was a higher occurrence of musculoskeletal involvement in patients with acute lymphoblastic leukemia, compared with those with acute myeloid leukemia (P < .05).
Additionally, hematologic abnormality occurred less frequently (P < .05), and peripheral blast cells were absent more often (P = .04), in the group with musculoskeletal involvement. The overall 5-year survival rate was not significantly different between those with and without musculoskeletal involvement — 48.2% vs. 57.4%, respectively.
Other differences between the cohorts included a “slightly higher” initial onset of disease among patients with musculoskeletal involvement. Additionally, patients with musculoskeletal involvement were more likely to be diagnosed with acute lymphoblastic leukemia (88.9%) than acute myeloid leukemia (11.1%).
“Childhood leukemia with MSK involvement had the notable characteristics of minimal or absent hematologic abnormalities and peripheral blast counts,” Kittivisuit and colleagues wrote. “The survival outcomes were not different between those with and without MSK involvement. As the clinical and laboratory signs of leukemia can be obscured at initial presentation, clinicians should be aware of the possibility of leukemia in children who present with MSK complaints.”
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