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PEDIATRICS Vol. 100 No. 1 July 1997, pp. 60-64

Cutaneous Involvement in Children With Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma

Received Dec 9, 1996; accepted Dec 9, 1996.

Frédéric Millot*, Alain RobertDagger , Yves Bertrand§, Françoise Mechinaudparallel , Geneviève Laureys, Alice Ferster#, Pénélope Brock**, Pierre RohrlichDagger Dagger , Françoise Mazingue§§, Dominique Plantaz||, Emmanuel Plouvier¶¶, Hélène Pacquement##, Catherine Behar***, Xavier RiallandDagger Dagger Dagger , Jean-Marie Chantraine§§§, François Guilhot*, Jacques Ottenparallel parallel parallel , and for the Children's Leukemia Cooperative Group of the European Organization of Research and Treatment of Cancer (EORTC)

From the * Department of Hematology, University Hospital of Poitiers, France; and the Departments of Pediatrics and Hematology: Dagger  University Hospital of Toulouse, France; § University Hospital of Lyon, France; parallel  University Hospital of Nantes, France;  University Hospital of Gent, Belgium; # Queen Fabiola University Hospital of Brussels, Belgium; ** University Hospital of Leuven, Belgium; Dagger Dagger  Robert Debré Hospital, Paris, France; §§ University Hospital of Lille, France; || University Hospital of Grenoble, France; ¶¶ University Hospital of Besançon, France; ## Institut Curie, Paris, France; *** University Hospital of Reims, France; Dagger Dagger Dagger  University Hospital of Angers, France; §§§ University Hospital of Liege, Belgium; and parallel parallel parallel  University Hospital of Brussels, Belgium.

Objective.  Skin involvement in children with acute monocytic leukemia or CD30-positive anaplastic large-cell lymphoma is well-known. In contrast, very little is known about the malignant cutaneous infiltrates in children with acute lymphoblatic leukemia (ALL) or lymphoblastic lymphoma (LBL). This study was designed to determine the frequency of these specific lesions in childhood ALL or LBL and the characteristics of such patients.

Design.  We studied the clinical and biological findings of children with cutaneous involvement at initial diagnosis of ALL or LBL enrolled between August 1989 and March 1995 in the multicentric trial 58881 of the Children's Leukemia Cooperative Group of the European Organization of Research and Treatment of Cancer (EORTC).

Results.  Among the 1359 children enrolled in the multicenter trial EORTC 58881, 24 presented with skin involvement at diagnosis. ALL was diagnosed in 15 patients and LBL in 9. In 15 cases, skin lesions were observed within a median time of 6 weeks (range, a few days to 8 months) before the diagnosis of the hematologic disease. Twenty-one children had at least one skin lesion located on the head. Diffuse cutaneous lesions were observed in 7 infants with high-risk ALL. Seventeen of the 24 children remain in the first complete remission (median follow-up of 3 years; range 2 months to 5 years) and 3 are in the second remission with a follow-up of 14 to 24 months.

Conclusion.  The present study demonstrates that cutaneous involvement can be an early manifestation of ALL or LBL. Cutaneous leukemic infiltrates can be observed in children with standard risk as well as in high-risk ALL. Cutaneous involvement in children with LBL is mainly associated with a B-cell precursor immunophenotype of the lymphomatous cells. The most frequent location of skin lesions in children with ALL or LBL is on the head. Further studies are needed to evaluate the prognosis of children with such involvement at diagnosis.

Key words: lymphoblastic leukemia, lymphoblastic lymphoma, children, skin leukemia, skin disease.


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