Chronic myeloid leukemia in children: a rare and unique entity

Chronic myeloid leukemia (CML) rarely occurs in the first two decades of life, accounting for 2% to 3% of leukemias in children and adolescents. Because of a lack of robust clinical study evidence, management of CML in children is not standardized and often follows guidelines developed for adults. Children and young adults tend to have a more aggressive clinical presentation than older adults, and recent data indicate that some genetic differences exist in pediatric and adult CML. Because children with CML may receive tyrosine kinase inhibitor (TKI) therapy for many decades, and are exposed to TKIs during a period of active growth, the acute and long-term toxicities of this option should be carefully evaluated against the complications associated with lifelong use of TKIs. This review aims to outlines the morphological, genetic and immuno-phenotypical findings of pediatric CML, and to recommend a uniform approach for the diagnostic procedures to be applied and for standardized treatment.