Figure 1.
![Incidence statistics of childhood acute leukemias in 2020 in WHO regions. a. Number of new cases; b. Number of new deaths [1,10]](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/65e6324ea96a436ce011782e/j_ahem-2023-0023_fig_001.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA6AP2G7AKPD7DO3RW%2F20251211%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20251211T083046Z&X-Amz-Expires=3600&X-Amz-Security-Token=IQoJb3JpZ2luX2VjEB0aDGV1LWNlbnRyYWwtMSJIMEYCIQCHH1Ft%2BnsekTrSd9fFl%2B%2FSQCxLLYRNaXLCIO1XfotP8AIhAKwTB8oux7yuk8ZbZzKjPwmNxiy5qQarbGIcJ5qQ84RTKsYFCOb%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEQAhoMOTYzMTM0Mjg5OTQwIgyF3Sk5hde3jE131F4qmgXuzwu9nCerGzXuV2%2FB5RWy3ED2Fnjz1gokoE5HIdBHeYEqgdbwzd0xvThcwlK1Q9NAsHolepTzWcvHKsVhxgzVewfZe%2BkRE2hv2PYAd9wPkOiSzapWMJ5KJiXniDjDjFt8E1Xz2pK8j7gqP4hhnnfVdYysvANGCVTS55GuZ24xiGUDZ0MqbD4lltzQch%2BHuCDzqT%2BbdOQI8k3551k8o2CXfs%2Bc1ieQKvMlYnzKsn3oaYVcGHSmHwjCSV7Ind2CJS01tEHR%2FVvPR6SBMQ4aJrsO%2B%2BlLM7eokUsurKCCax5ExbiDhVY7fNb85s8AzSvFKNyJEkAVpUQXfDNAVZ0EyIbstfwJRQ7fy6O8GDYjEKrIZZu948nlsHsEIzoxqOQLUfyzsW9Wc3UOIncIp80Und6TEb12M31tTLWX3%2BYrjrhBnHDdDJzQkJQnz96E%2Flp1MsT8IcmNIabSX2N58yE3txByCVhFv%2BX8YKwoLSj9auNM62kvHPSAcM05gepKeh6YhIhZAhupah24m0%2B%2FN9Wug%2Bp8yW6PNuCNAkkli7BxWeSYVc4OSTFVjiU2Y%2BCVVRja0ax%2BG%2BHVIW0mlnpH7pStjjN3DJbfpUE1ovXUvDvzLohi2LurgD6IgrzCRXkU9Tn%2Bibb7AVNZ6wjaL%2BvR2jzY5CFELGckY1kFGUf%2F56e27Pnk3lDhPScoijr4OcEAgfO8g5cMWVUyY31SgL7IHQWCRXSGrAQsRiP0qybz02TebeUsLogVP67V9BnSXgmPNFZvlBgTr5EjpTa0fzTTF76wBPE21TFu1OUKKBWjjU5LY41HVFCp%2BDMVbYCBCM1N28dpm657QufUsTNou1K8Yd70JePuVu9kE%2BxFTynKveYqiy%2B669iFTHbckttXkpYw0aPpyQY6sAHwHYAjPujBNItyESfO8wR1y%2F7C8r3ATn0jW8a71Ipk3cJfDBxa7wN00MC3zK35roRyb5os6%2FiWwbcBZFYD9TsQUIvhWM9pEKLrb7VzLbJZVazXsq1vbTtEvQa29ezp61kx%2BZgLL4SFsi0woL0yLeosu42YL2pj20UlF5mMnjFz99rhi9MRQRJYqpHIrdtuxD3%2Bc%2Fc0D2NggKUE5ZSn5P8e0iwBR7UQDd2End5Yc005yw%3D%3D&X-Amz-Signature=c73c06a4bb6d9bfb5c626176195974e410a1ad6a7c024b2a75e49b5be17a2e19&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
Figure 2.
![Incidence trends of pediatric leukenia in 2020–2030. a. Percent of new cases; b. Percent of new deaths [16]](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/65e6324ea96a436ce011782e/j_ahem-2023-0023_fig_002.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA6AP2G7AKPD7DO3RW%2F20251211%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20251211T083046Z&X-Amz-Expires=3600&X-Amz-Security-Token=IQoJb3JpZ2luX2VjEB0aDGV1LWNlbnRyYWwtMSJIMEYCIQCHH1Ft%2BnsekTrSd9fFl%2B%2FSQCxLLYRNaXLCIO1XfotP8AIhAKwTB8oux7yuk8ZbZzKjPwmNxiy5qQarbGIcJ5qQ84RTKsYFCOb%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEQAhoMOTYzMTM0Mjg5OTQwIgyF3Sk5hde3jE131F4qmgXuzwu9nCerGzXuV2%2FB5RWy3ED2Fnjz1gokoE5HIdBHeYEqgdbwzd0xvThcwlK1Q9NAsHolepTzWcvHKsVhxgzVewfZe%2BkRE2hv2PYAd9wPkOiSzapWMJ5KJiXniDjDjFt8E1Xz2pK8j7gqP4hhnnfVdYysvANGCVTS55GuZ24xiGUDZ0MqbD4lltzQch%2BHuCDzqT%2BbdOQI8k3551k8o2CXfs%2Bc1ieQKvMlYnzKsn3oaYVcGHSmHwjCSV7Ind2CJS01tEHR%2FVvPR6SBMQ4aJrsO%2B%2BlLM7eokUsurKCCax5ExbiDhVY7fNb85s8AzSvFKNyJEkAVpUQXfDNAVZ0EyIbstfwJRQ7fy6O8GDYjEKrIZZu948nlsHsEIzoxqOQLUfyzsW9Wc3UOIncIp80Und6TEb12M31tTLWX3%2BYrjrhBnHDdDJzQkJQnz96E%2Flp1MsT8IcmNIabSX2N58yE3txByCVhFv%2BX8YKwoLSj9auNM62kvHPSAcM05gepKeh6YhIhZAhupah24m0%2B%2FN9Wug%2Bp8yW6PNuCNAkkli7BxWeSYVc4OSTFVjiU2Y%2BCVVRja0ax%2BG%2BHVIW0mlnpH7pStjjN3DJbfpUE1ovXUvDvzLohi2LurgD6IgrzCRXkU9Tn%2Bibb7AVNZ6wjaL%2BvR2jzY5CFELGckY1kFGUf%2F56e27Pnk3lDhPScoijr4OcEAgfO8g5cMWVUyY31SgL7IHQWCRXSGrAQsRiP0qybz02TebeUsLogVP67V9BnSXgmPNFZvlBgTr5EjpTa0fzTTF76wBPE21TFu1OUKKBWjjU5LY41HVFCp%2BDMVbYCBCM1N28dpm657QufUsTNou1K8Yd70JePuVu9kE%2BxFTynKveYqiy%2B669iFTHbckttXkpYw0aPpyQY6sAHwHYAjPujBNItyESfO8wR1y%2F7C8r3ATn0jW8a71Ipk3cJfDBxa7wN00MC3zK35roRyb5os6%2FiWwbcBZFYD9TsQUIvhWM9pEKLrb7VzLbJZVazXsq1vbTtEvQa29ezp61kx%2BZgLL4SFsi0woL0yLeosu42YL2pj20UlF5mMnjFz99rhi9MRQRJYqpHIrdtuxD3%2Bc%2Fc0D2NggKUE5ZSn5P8e0iwBR7UQDd2End5Yc005yw%3D%3D&X-Amz-Signature=7b6934cdb624edea10330ed01669e2b34700b0138082360e92f32815daaecf67&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
Figure 3.
![a. Incidence percantage of childhood ALL by age; b. Incidence percantageof childood AML by age [17,18,19]](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/65e6324ea96a436ce011782e/j_ahem-2023-0023_fig_003.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA6AP2G7AKPD7DO3RW%2F20251211%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20251211T083046Z&X-Amz-Expires=3600&X-Amz-Security-Token=IQoJb3JpZ2luX2VjEB0aDGV1LWNlbnRyYWwtMSJIMEYCIQCHH1Ft%2BnsekTrSd9fFl%2B%2FSQCxLLYRNaXLCIO1XfotP8AIhAKwTB8oux7yuk8ZbZzKjPwmNxiy5qQarbGIcJ5qQ84RTKsYFCOb%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEQAhoMOTYzMTM0Mjg5OTQwIgyF3Sk5hde3jE131F4qmgXuzwu9nCerGzXuV2%2FB5RWy3ED2Fnjz1gokoE5HIdBHeYEqgdbwzd0xvThcwlK1Q9NAsHolepTzWcvHKsVhxgzVewfZe%2BkRE2hv2PYAd9wPkOiSzapWMJ5KJiXniDjDjFt8E1Xz2pK8j7gqP4hhnnfVdYysvANGCVTS55GuZ24xiGUDZ0MqbD4lltzQch%2BHuCDzqT%2BbdOQI8k3551k8o2CXfs%2Bc1ieQKvMlYnzKsn3oaYVcGHSmHwjCSV7Ind2CJS01tEHR%2FVvPR6SBMQ4aJrsO%2B%2BlLM7eokUsurKCCax5ExbiDhVY7fNb85s8AzSvFKNyJEkAVpUQXfDNAVZ0EyIbstfwJRQ7fy6O8GDYjEKrIZZu948nlsHsEIzoxqOQLUfyzsW9Wc3UOIncIp80Und6TEb12M31tTLWX3%2BYrjrhBnHDdDJzQkJQnz96E%2Flp1MsT8IcmNIabSX2N58yE3txByCVhFv%2BX8YKwoLSj9auNM62kvHPSAcM05gepKeh6YhIhZAhupah24m0%2B%2FN9Wug%2Bp8yW6PNuCNAkkli7BxWeSYVc4OSTFVjiU2Y%2BCVVRja0ax%2BG%2BHVIW0mlnpH7pStjjN3DJbfpUE1ovXUvDvzLohi2LurgD6IgrzCRXkU9Tn%2Bibb7AVNZ6wjaL%2BvR2jzY5CFELGckY1kFGUf%2F56e27Pnk3lDhPScoijr4OcEAgfO8g5cMWVUyY31SgL7IHQWCRXSGrAQsRiP0qybz02TebeUsLogVP67V9BnSXgmPNFZvlBgTr5EjpTa0fzTTF76wBPE21TFu1OUKKBWjjU5LY41HVFCp%2BDMVbYCBCM1N28dpm657QufUsTNou1K8Yd70JePuVu9kE%2BxFTynKveYqiy%2B669iFTHbckttXkpYw0aPpyQY6sAHwHYAjPujBNItyESfO8wR1y%2F7C8r3ATn0jW8a71Ipk3cJfDBxa7wN00MC3zK35roRyb5os6%2FiWwbcBZFYD9TsQUIvhWM9pEKLrb7VzLbJZVazXsq1vbTtEvQa29ezp61kx%2BZgLL4SFsi0woL0yLeosu42YL2pj20UlF5mMnjFz99rhi9MRQRJYqpHIrdtuxD3%2Bc%2Fc0D2NggKUE5ZSn5P8e0iwBR7UQDd2End5Yc005yw%3D%3D&X-Amz-Signature=8eb2e11068de85bab91dd22df35683e59ecf5c3138beee0a31b797676e87acf8&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
Estimated number of new cases and mortality in 2020 for childhood leukemia [20,21]
| Population | New incident | Mortality | ||
|---|---|---|---|---|
| Females | Male | Females | Male | |
| WHO South-East Asia | 40.8 % | 59.2 % | 38.3 % | 61.7 % |
| WHO Western Pacific | 40.6 % | 59.4 % | 43.1 % | 56.9 % |
| WHO Americas | 44 % | 56 % | 41.5 % | 58.5 % |
| WHO East Mediterranean | 43.5 % | 56.5 % | 40.1 % | 59.9 % |
| WHO Europe | 41.7 % | 58.3 % | 42.1 % | 57.9 % |
| WHO Africa | 42.3 % | 57.7 % | 43.9 % | 56.1 % |
| all WHO regions | 42.1 % | 57.9 % | 41.5 % | 58.5 % |
Genetic predisposition to childhood leukemia
| Acquired syndromes/Genetic disorders | Type of leukemia | Mutation | |
|---|---|---|---|
| Down Syndrome | |||
| Down Syndrome (DS) | ALL/AML |
| |
| DNA repair gene syndromes and chromosomal instability syndromes | |||
| Fanconi anemia (FA) | MDS/AML | FANCA | |
| Bloom’s syndrome (BS) |
| BLM | |
| Ataxia-telangiectasia (AT) | ALL | ATM | |
| Constitutional Mismatch Repair Deficiency (CMMRD) | ALL |
| |
| Robertson translocation(RT) | ALL | ||
| Tumor suppressor gene syndromes | |||
| Li-Fraumeni syndrome(LFS) | ALL | TP53 | |
| Neurofibromatosis (NF1) | ALL AML (JMML) | NF1 | |
| Beckwith-Wiedemann syndrome (BWS) | ALL | CDKN1C | |
| Pure familial leukemia | |||
| Acquired monosomy 7 | MDS/AML | Unknown | |
| Hereditary platelet disorders (HPDs) | MDS/AML |
| |
| Bone marrow failure syndromes | |||
| Shwachman-Diamond syndrome (SDS) | AML | SDS | |
| Diamond Blackfan anemia (DBA) | MDS/AML | DBA | |
| Congenital amegakaryocytic thrombocytopenia (CAMT) | MDS/AML | c-Mpl | |
| Cyclic neutropenia (CyN) | MDS/AML | ELANE | |
| Severe congenital neutropenia (SCN) | AML | ELANE HAX1 | |
| Amegakaryocytic thrombocytopenia (AMT) | MDS/AML | c-MPL | |
| Hereditary platelet disorders (HPDs) | MDS/AML |
| |
| Aplastic anemia (AA) | MDS/AML |
| |
The International Consensus Classification of AML [9]
| AML with defining genetic abnormalities |
| AML with RUNX1::RUNX1T1 Fusion |
| AML with CBFB::MYH11 Fusion |
| Acute promyelocytic leukaemia with PML::RARA Fusion |
| AML with KMT2A rearrangement |
| AML with DEK::NUP214 Fusion |
| AML with MECOM rearrangement |
| AML with RBM15::MRTFA Fusion |
| AML with NUP98 rearrangement |
| AML with other (rare) defined genetic alterations |
| AML with NPM1 mutation |
| AML with CEBPA mutation |
| AML defined by differentiation |
| AML with minimal differentiation |
| AML without maturation |
| AML with maturation |
| Acute myelomonocytic leukemia |
| Acute monoblastic/monocytic leukemia |
| Pure erythroid leukemia |
| Acute megakaryoblastic leukemia |
| Acute basophilic leukemia |
The International Consensus Classification of ALL [6]
| B-ALL with t(12;21)(p13.2;q22.1)/ETV6::RUNX1 |
| B-ALL. hyperdiploid |
| B-ALL. low hypodiploid |
| B-ALL. near haploid |
| B-ALL with t(5;14)(q31.1;q32.3)/IL3::IGH |
| B-ALL with t(1;19)(q23.3;p13.3)/TCF3::PBX1 |
| B-ALL. BCR::ABL1–like, ABL-1 class rearranged |
| B-ALL. BCR::ABL1–like, JAK-STAT activated |
| B-ALL. BCR::ABL1–like, NOS (undefined) |
| B-ALL with iAMP21 |
| B-ALL with MYC rearrangement |
| B-ALL with DUX4 rearrangement |
| B-ALL with MEF2D rearrangement |
| B-ALL with ZNF384(362) rearrangement |
| B-ALL with NUTM1 rearrangement |
| B-ALL with HLF rearrangement |
| B-ALL with UBTF::ATXN7L3/PAN3,CDX2 (“CDX2/UBTF”) |
| B-ALL with mutated IKZF1 N159Y |
| B-ALLwith mutated PAX5 P80R |
| Provisional entity: B-ALL. ETV6::RUNX1-like |
| Provisional entity: B-ALL. with PAX5 alteration |
| Provisional entity: B-ALL. with mutated ZEB2 (p.H1038R)/IGH::CEBPE |
| Provisional entity: B-ALL. ZNF384 rearranged-like |
| Provisional entity: B-ALL. KMT2A rearranged-like |
| B-ALL, NOS (undefined) |
| T-ALL |
| Early T-cell precursor ALLwith BCL11B rearrangement |
| Early T-cell precursor ALL. NOS |
| T-ALL. NOS |
| Provisional entity: natural killer cell ALL |