Objective:

To investigate the prevalence and pattern of liver involvement at diagnosis of pediatric acute leukemia and its associations with clinical features and prognosis, highlighting its significance in risk assessment.

Key Findings:

• Liver involvement prevalence: T-ALL (80.0%), pre-B-ALL (64.0%), AML (37.0%) (P<0.001), indicating significant variation across subtypes.
• HM was the most common manifestation across all subtypes, underscoring its clinical importance.
• Lower platelet counts correlated with HM and HI in pre-B-ALL, and with HD in T-ALL, suggesting a potential biomarker for monitoring.
• HI positively correlated with age in pre-B-ALL, indicating age-related risk factors.
• Complex hepatic injury in AML was associated with poorer outcomes: 5-year OS of 58.3% vs. 87.5% in those without liver involvement, emphasizing the need for targeted interventions.

Interpretation:

Liver involvement in pediatric acute leukemia shows subtype-specific patterns and is associated with clinical features such as age, WBC, and platelet counts. Complex hepatic injury may serve as an adverse prognostic marker for AML, influencing treatment strategies.

Limitations:

• Single-center study may limit generalizability; multicenter studies are needed.
• Retrospective design may introduce bias; prospective studies could validate findings.
• Limited follow-up duration for long-term outcomes; future research should focus on extended follow-up.

Conclusion:

Liver involvement in pediatric acute leukemia varies by subtype and is linked to specific clinical features, with complex hepatic injury being a potential adverse prognostic factor for AML, warranting further investigation.