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DOI: 10.1055/s-2008-1077661
© Georg Thieme Verlag KG Stuttgart · New York
Leukämien im Kindesalter
Publikationsverlauf
Publikationsdatum:
04. Dezember 2008 (online)
![](https://www.thieme-connect.de/media/paedu2d/200804/lookinside/thumbnails/10.1055-s-2008-1077661-1.jpg)
Einleitung
Kinder, die wegen Bauchschmerzen, Fieber, Schlappheit oder Blässe beim Kinderarzt vorgestellt werden, sind in der überwiegenden Mehrzahl der Fälle nicht schwer erkrankt. Gerade deshalb ist es für die tägliche Praxis wichtig, jene Kinder zu identifizieren, die einer weiterführenden Diagnostik bedürfen. Welche Untersuchungen im Rahmen einer rationalen Abklärung notwendig sind, ist abhängig vom klinischen Zustand der Patienten und von Begleitsymptomen.
Merke: Bei jedem Patienten, bei dem das klinische Bild nicht eindeutig einer Gruppe von Erkrankungen zuzuordnen ist, sollte auch an die Möglichkeit einer malignen Erkrankung gedacht und diese abgeklärt werden.
Abb. 1 Röhrchen mit leukämischem Blut nach Sedimentation. Zwischen der oberen klaren (Serum) und unteren tiefroten Fraktion (Erythrozyten) stellt sich eine große weiße Fraktion mit „weißem Blut”, den Leukämiezellen, dar.
Der Begriff Leukämien („weißes Blut”) wurde 1845 durch Rudolf Virchow geprägt. Sein Bericht über das „weiße Blut” gilt als Erstbeschreibung der Leukämien (Abb. [1]). In Deutschland erkranken jährlich ca. 1800 Kinder unter 15 Jahren an einem bösartigen Tumor [1]. Dabei treten mehr solide als hämatologische maligne Tumoren auf (55 % versus 45 %, Abb. [2 a]). Die Häufigkeitskurve der malignen Tumoren im Kindes- und Jugendalter zeigt zwei Altersgipfel, einen etwa bis zum 5. Lebensjahr, den anderen vom 14. – 19. Lebensjahr (Abb. [2 b]).
Dieser Artikel soll einen Überblick über die klinische Präsentation, die Diagnostik, die Klassifikation und die Behandlungsmöglichkeiten von Leukämien im Kindesalter geben.
Abb. 2 Epidemiologie von Tumorerkrankungen. a Prozentuales Verteilungsmuster der Tumorerkrankungen im Kindesalter in Deutschland [1]. b Alterspezifische Inzidenz von Krebserkrankungen in Europa in den 1970er, 1980er und 1990er Jahren. Die P-Werte geben den Unterschied zwischen der ersten und der letzten Dekade an [2]. c Prozentuales Verteilungsmuster der Leukämien im Kindesalter in Deutschland [1].
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PD Dr. med. Melchior Lauten
Zentrum für Kinder- und JugendmedizinUniversitätsklinikum Freiburg
Mathildenstr. 12
70106 Freiburg
Fax: 0761-270 4918
eMail: melchior.lauten@uniklink-freiburg.de