General Information

What is childhood acute myeloid leukemia?

Childhood acute myeloid leukemia (AML) is a cancer of the blood-forming tissue, primarily the bone marrow and lymph nodes. AML is also called acute nonlymphocytic leukemia or acute myelogenous leukemia, and is divided into several subtypes. It is less common than acute lymphocytic leukemia (also called acute lymphoblastic leukemia or ALL), another form of leukemia that occurs in children. Children with Down syndrome have an increased risk of AML during the first 3 years of life.

All types of blood cells are produced by the bone marrow. The bone marrow is the spongy tissue inside the large bones of the body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which help make the blood clot).

The bone marrow produces new blood cells. In leukemia the bone marrow starts producing large numbers of abnormal blood cells usually white blood cells. These abnormal, immature white blood cells are called blasts. These cells flood the blood stream and lymph system, and may invade vital organs such as the brain, testes, ovaries, or skin. Acute promyelocytic leukemia is a rare type of AML that prevents blood from clotting normally. In rare cases, AML tumor cells form a solid tumor called an isolated granulocytic sarcoma or chloroma.

Leukemia can be acute (progressing quickly with many immature blasts) or chronic (progressing slowly with more mature-looking cancer cells). Acute myeloid leukemia can occur in both children and adults. Treatment is different for adults than it is for children. (Refer to Adult Myeloid Leukemia Treatment; Chronic Lymphocytic Leukemia Treatment; Chronic Myelogenous Leukemia Treatment; Adult Acute Lymphoblastic Leukemia Treatment; Childhood Acute Lymphoblastic Leukemia Treatment; and Hairy Cell Leukemia Treatment for more information.)

Early signs of AML may be fever, chills, bleeding or bruising easily, swollen lymph nodes, and other symptoms similar to those of the flu, such as feeling weak or tired all the time, with aching bones or joints. If your child has symptoms of leukemia, his or her doctor may order a blood test to count the number of cells and examine them under a microscope. If the results of the blood tests are not normal, a bone marrow biopsy may be performed. During this test, a needle is inserted into a bone in the hip and a small amount of bone marrow is removed and examined under a microscope, enabling the doctor to determine what kind of leukemia your child has and plan the best treatment. Chromosomal analysis may also be performed. These additional tests can help distinguish AML from ALL and other leukemias and allow doctors to better plan treatment.

Other childhood myeloid malignancies:

Myelodysplastic syndromes (MDS) are disorders of the blood-forming cells. Myelodysplastic syndromes usually cause a deficiency in white blood cells, red blood cells, and platelets, and may lead to AML.

Juvenile myelomonocytic leukemia (JMML) is an extremely rare cancer of the blood-forming cells. Children with neurofibromatosis 1 (NF1) are at an increased risk for developing JMML.

Stage Explanation

There is no staging for acute myeloid leukemia (AML). AML is always spread throughout the bloodstream at the time of diagnosis, and sometimes invades other body tissue. Patients are often grouped according to whether or not they have been previously treated for leukemia.

Untreated
Untreated AML means that no treatment has yet been given except to alleviate or treat symptoms of the disease. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia. In rare cases, AML tumor cells appear as a solid tumor called an isolated granulocytic sarcoma or chloroma.

In remission
Remission means that the numbers of white blood cells and other cells in the blood and bone marrow are approaching normal following initial treatment with chemotherapy and that there are no signs or symptoms of leukemia.

Recurrent/refractory
Recurrent means that the leukemia has come back (recurred) after going into remission. Refractory means that the leukemia failed to go into remission following treatment.

Treatment Option Overview

How childhood acute myeloid leukemia (AML) is treated:

There are treatments for all patients with childhood acute myeloid leukemia (AML). Experienced doctors working together may provide the best treatment for children with AML. Your child's treatment will often be planned by a team of childhood cancer specialists with experience and expertise in treating leukemias of childhood.

The primary treatment for AML is chemotherapy, sometimes followed by bone marrow transplantation. Radiation therapy may be used in certain cases. Biological therapy is also being studied in clinical trials.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs may be taken by mouth or injected into a vein (intravenous injection) or a muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy may sometimes be injected into the fluid that surrounds the brain and spinal cord (intrathecal chemotherapy).

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for AML usually comes from a machine outside the body (external radiation therapy).

Bone marrow transplantation, a newer type of treatment, is used to replace the patient's bone marrow with healthy bone marrow. First, high doses of chemotherapy with or without radiation therapy are given to destroy all of the bone marrow in the body. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or another person not related. The healthy marrow from the donor is given to the patient through a needle in a vein, and the healthy marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or person not related is called an allogeneic bone marrow transplant.

Another type of bone marrow transplant, called autologous bone marrow transplant, may be used. During this procedure, bone marrow is taken from the patient and may be treated with drugs to kill any cancer cells. The marrow is then frozen to save it. Next, the patient is given high-dose chemotherapy, with or without radiation therapy, to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and returned to the patient to replace the marrow that was destroyed.

Biological therapy attempts to stimulate or restore the ability of the patient's immune system to fight cancer. It uses substances produced by the patient's own body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier therapy or immunotherapy.

Treatment for AML is ordinarily divided into 2 phases: induction and consolidation. A third phase, intensification, may also be used. During induction therapy, chemotherapy is used to kill as many of the leukemia cells as possible and cause the leukemia to go into remission. Once the leukemia goes into remission and there are no signs of leukemia, consolidation therapy is given. The purpose of postremission therapy (consolidation and intensification) is to kill any remaining leukemia cells. Your child may receive either or both phases of postremission therapy.

As preventive therapy, your child may also receive central nervous system (CNS) prophylaxis, which consists of intrathecal and/or high-dose systemic chemotherapy to the central nervous system (CNS) to kill any leukemia cells present there, or to prevent the spread of cancer cells to the brain and spinal cord even if no cancer has been detected there. Radiation therapy to the brain may also be given, in addition to chemotherapy, for this purpose.

Unwanted side-effects can result from treatment long after it ends, so it is important that your child continue to be seen by his or her doctor. Chemotherapy can lead to heart, kidney, and hearing problems after treatment is finished. Radiation therapy may cause problems with growth and development.

Treatment for childhood AML depends on whether or not the patient has been previously treated for leukemia and the type of leukemia. The best treatment is given by cancer doctors with experience in treating children with leukemia, and is given at hospitals where leukemia patients are often treated.

Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child take part in a clinical trial. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients, and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most types of childhood AML. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Untreated Childhood Acute Myeloid Leukemia and Other Childhood Myeloid Malignancies
Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child take part in a clinical trial. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients, and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most types of childhood AML. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615

Childhood acute myeloid leukemia
Your child's treatment will probably be induction chemotherapy using 2 or more chemotherapy drugs to kill cancer cells and cause the leukemia to go into remission. Induction chemotherapy is usually successful in inducing remission. Intrathecal chemotherapy with or without radiation therapy to the brain may be given to prevent the spread of cancer cells to the brain and spinal cord. Biological therapy may be added to treatment to help your child recover more quickly from the side effects of induction therapy.

Acute promyelocytic leukemia
Treatment for acute promyelocytic leukemia (APL) may include all-trans retinoic acid (ATRA) combined with chemotherapy. Arsenic trioxide is also being studied in children with APL.

Children With Down syndrome
Treatment for children with Down syndrome who have AML is chemotherapy.

Myelodysplastic syndrome
Treatment for myelodysplastic syndromes may include chemotherapy followed by bone marrow or peripheral stem cell transplantation.

Juvenile myelomonocytic leukemia
Treatment for children with juvenile myelomonocytic leukemia may be peripheral stem cell transplantation, cis-retinoic acid, and chemotherapy.

Childhood Acute Myeloid Leukemia in Remission
Treatment will consist of additional chemotherapy or bone marrow transplantation. Central nervous system prophylaxis and/or maintenance chemotherapy may also be given in some cases.

Recurrent Childhood Acute Myeloid Leukemia
Treatment depends on the type of treatment your child received before. You may want to consider entering your child into a clinical trial. Treatments currently being studied in clinical trials include new chemotherapy drugs, bone marrow transplantation, and biological therapy. Treatment for recurrent acute promyelocytic leukemia (APL) may consist of arsenic trioxide or regimens including all-trans retinoic acid.

Unwanted side effects can result from treatment long after it ends, so it is important that your child continue to be seen by his or her doctor. Chemotherapy can later lead to heart problems, as well as kidney and hearing problems. Radiation therapy may interfere with a child's growth and may increase the risk of hormonal dysfunction and cataract formation.







The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

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