CUTANEOUS INVOLVEMENT IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA OR LYMPHOBLASTIC LYMPHOMA

Objective. Skin involvement in children with acute monocytic leukemia or CD30-positive anaplastic large-cell lymphoma is well-known. In cont rast, very little is known about the malignant cutaneous infiltrates i n children with acute lymphoblatic leukemia (ALL) or lymphoblastic lym phoma (LBL). This study was designed to determine the frequency of the se specific lesions in childhood ALL or LBL and the characteristics of such patients. Design. We studied the clinical and biological finding s of children with cutaneous involvement at initial diagnosis of ALL o r LBL enrolled between August 1989 and March 1995 in the multicentric trial 58881 of the Children's Leukemia Cooperative Group of the Europe an 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 wit hin a median time of 6 weeks (range, a few days to 8 months) before th e diagnosis of the hematologic disease. Twenty-one children had at lea st one skin lesion located on the head. Diffuse cutaneous lesions were observed in 7 infants with high-risk ALL. Seventeen of the 24 childre n 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 f ollow-up of 14 to 24 months. Conclusion. The present study demonstrate s that cutaneous involvement can be an early manifestation of ALL or L BL. Cutaneous leukemic infiltrates can be observed in children with st andard risk as well as in highrisk ALL. Cutaneous involvement in child ren with LBL is mainly associated with a B-cell precursor immunophenot ype of the lymphomatous cells. The most frequent location of skin lesi ons in children with ALL or LBL is on the head. Further studies are ne eded to evaluate the prognosis of children with such involvement at di agnosis.