Diagnosis and Management of Acute Leukemias in Infants

Epidemiology and Age-Specific Considerations

Chronic myeloid leukemia (CML) is exceedingly rare in infants and typically presents differently with marked leukocytosis rather than pancytopenia, according to the American Society of Hematology 1
Infants under 2 years with AML have distinct biology, with MLL rearrangements occurring in ≥50% of cases in this age group, which is nearly exclusive to young children, as reported by the American Society of Clinical Oncology 2
AML in infants commonly presents with organomegaly and pancytopenia, particularly when associated with life-threatening symptoms from organ infiltration, as noted by the National Comprehensive Cancer Network 3
AML in infants commonly presents with organomegaly and pancytopenia, particularly when associated with life-threatening symptoms from organ infiltration, with a strength of evidence level of high, according to the European Society for Medical Oncology 4

Peripheral blood smear is essential to look specifically for circulating blasts, which when present confirm acute leukemia, though their absence does not exclude the diagnosis, as recommended by the College of American Pathologists 5
Bone marrow aspiration and biopsy with morphology, cytochemistry, immunophenotyping by flow cytometry, and cytogenetic analysis are necessary to distinguish ALL from AML and identify MLL rearrangements or other prognostic markers, according to the World Health Organization 2
Bone marrow aspiration and biopsy with morphology, cytochemistry, immunophenotyping by flow cytometry, and cytogenetic analysis are necessary to distinguish ALL from AML and identify MLL rearrangements or other prognostic markers, with a strength of evidence level of high, as reported by the International Society for Laboratory Hematology 3
Bone marrow aspiration and biopsy with morphology, cytochemistry, immunophenotyping by flow cytometry, and cytogenetic analysis are necessary to distinguish ALL from AML and identify MLL rearrangements or other prognostic markers, as noted by the European Hematology Association 4