Lyngdoh Konsam Samuel, Dhruti Pandya, Totadri Sidharth, Pal Somdipa, Munireddy Jyothi, Bharadwaj Vandana, Prakash Anand
Department of Pediatrics, St. John's Medical College and Hospital, Bengaluru, Karnataka, 560034, India.
Department of Pediatric Hematology Oncology and Bone Marrow Transplant, St. John's Medical College and Hospital, Bengaluru, Karnataka, 560034, India.
Indian Pediatr. 2025 Apr 7. doi: 10.1007/s13312-025-00064-y.
Children with acute lymphoblastic leukemia (ALL) with musculoskeletal (MSK) manifestations may be misdiagnosed as juvenile idiopathic arthritis (JIA). The present study compared the baseline parameters and survival outcomes in patients with ALL with and without MSK symptoms.
A retrospective chart review of children aged < 18 years diagnosed with ALL was performed. Based on contemporary parameters, the patients were stratified into standard-risk (SR), intermediate-risk (IR), and high-risk (HR) groups. Clinical and laboratory features and survival outcomes were compared between ALL patients with and without MSK symptoms.
Out of 255 participants, 67 (26%) had MSK manifestations; of these, 9 were pretreated for JIA with glucocorticoids/methotrexate. Patients with MSK manifestations had a longer median duration of symptoms before diagnosis (4 vs 2 weeks, P < 0.001), and a higher median platelet count (53 × 10/L vs. 28 × 10/L, P = 0.002). The 3-year event-free survival (EFS) for patients with MSK and without MSK manifestations were 84.4 ± 5.2% and 78.9 ± 3.4% (P = 0.900). All 9 pretreated patients received an IR/HR protocol (4 were SR if not for the pretreatment as JIA).
Patients with ALL with MSK manifestations have more preserved blood counts and a longer duration of symptoms before diagnosis. Pretreatment of children with ALL misdiagnosed as JIA with glucocorticoids/methotrexate can delay the diagnosis, confound the risk stratification, and upstage the risk group requiring administration of more toxic chemotherapy than necessary otherwise.
患有肌肉骨骼（MSK）表现的急性淋巴细胞白血病（ALL）儿童可能会被误诊为幼年特发性关节炎（JIA）。本研究比较了有和没有MSK症状的ALL患者的基线参数和生存结果。
对年龄＜18岁诊断为ALL的儿童进行回顾性病历审查。根据当代参数，将患者分为标准风险（SR）、中度风险（IR）和高风险（HR）组。比较有和没有MSK症状的ALL患者的临床和实验室特征及生存结果。
在255名参与者中，67名（26%）有MSK表现；其中9名曾用糖皮质激素/甲氨蝶呤进行过JIA的预处理。有MSK表现的患者在诊断前症状持续时间中位数更长（4周对2周，P＜0.001），血小板计数中位数更高（53×10/L对28×10/L，P = 0.002）。有和没有MSK表现的患者3年无事件生存率（EFS）分别为84.4±5.2%和78.9±3.4%（P = 0.900）。所有9名预处理患者均接受了IR/HR方案（如果不是作为JIA进行预处理，4名应为SR）。
有MSK表现的ALL患者血细胞计数保留更多，诊断前症状持续时间更长。用糖皮质激素/甲氨蝶呤对被误诊为JIA的ALL儿童进行预处理会延迟诊断，混淆风险分层，并使需要比原本必要情况使用更具毒性化疗的风险组分期上升。
