Challenging presentations and clinical management in pediatric liquid tumors: A case series

Abstract

Background: Pediatric acute leukemia’s represent a heterogeneous group of malignancies with variable prognoses. Although survival rates have improved significantly with risk-adapted protocols and advances in supportive care, management becomes complicated in the presence of comorbidity, age-related challenges, or rare molecular subtypes. Objective: The objective of the study was to present three pediatric cases – infantile acute myeloid leukemia, acute lymphoblastic leukemia in a child with Down syndrome, and acute promyelocytic leukemia with differentiation syndrome – demonstrating diagnostic dilemmas, therapeutic challenges, and the potential of modified regimens. Methods: Retrospective descriptive case series at a tertiary pediatric oncology unit, examining clinical profiles, treatment adaptations, and outcomes. Results: All patients achieved remission. Two required significant modifications due to toxicity or preexisting conditions. Integration of measurable residual disease-guided strategies, novel therapeutic agents like azacitidine and venetoclax, and aggressive management of complications led to favorable outcomes. Conclusion: Personalized protocols, vigilant monitoring, and early recognition of complications are essential in pediatric leukemia care. Incorporation of newer agents may rescue patients where traditional therapies fail or are poorly tolerated.