Childhood Acute Myeloid Leukemia
Table of Contents
What is childhood acute myeloid leukemia?
- Stage Explanation
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Stages of childhood acute myeloid leukemia
- Treatment Option Overview
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How childhood acute myeloid leukemia (AML) is treated
- Treatment by stage
- Untreated Childhood Acute Myeloid Leukemia
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- Childhood Acute Myeloid Leukemia in Remission
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- Recurrent Childhood Acute Myeloid Leukemia
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- To Learn More
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.
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 controls the production of normal cells. In leukemia, the process
breaks down and the bone marrow starts producing large numbers of abnormal cells of only
one type of cell, usually one of the white cells. These abnormal, immature cells, called
blasts, then flood the blood stream and lymph system, and may invade vital organs such as
the brain, testes, ovaries, or skin. AML tumor cells rarely can appear as 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
progresses quickly, and can occur in both children and adults. Treatment is different for
adults than it is for children. For information about the treatment of adult AML, see the
PDQ patient information statement on adult acute myeloid leukemia. Separate PDQ
information statements are also available for chronic lymphocytic leukemia, chronic
myelogenous leukemia, adult and childhood acute lymphocytic leukemia, and hairy cell
leukemia.
If your child has symptoms of leukemia, your child's doctor may order blood tests to
count the number of each of the different kinds of blood cells. 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.
Stages of childhood acute myeloid leukemia
There is no staging for acute myeloid leukemia (AML), since AML is always spread
throughout the bloodstream. Treatment depends on whether or not the patient has been
previously treated for leukemia.
Untreated
Untreated AML means no treatment has been given except to alleviate or the leukemia may
appear as a tumor called a chloroma.
In remission
Remission means that remission induction treatment has been given and that the number
of white blood cells and other cells in the blood and bone marrow is approaching normal.
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.
How childhood acute myeloid leukemia (AML) is treated
There are treatments for all patients with childhood acute myeloid leukemia (AML). 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.
A newer type of bone marrow transplant, called autologous bone marrow transplant, is
being studied in clinical trials. 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.
There are two or three phases of treatment for AML. The first phase, remission
induction therapy, uses chemotherapy 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, postremission therapy is given. The purpose of postremission
therapy is to kill any remaining leukemia cells. Postremission therapy is divided into two
phases, postremission consolidation and postremission intensification. 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 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,
kidney, and hearing problems. Radiation therapy may later lead to problems with growth and
development, and with sight.
Treatment by stage
Treatment for childhood AML depends on 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. If you want more information, call the Cancer
Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Your child's treatment will probably be remission induction chemotherapy 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.
Clinical trials are currently testing chemotherapy with or without bone marrow
transplantation.
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,
Clinical trials are currently testing bone marrow transplantation, as well as different
chemotherapy treatments and ways to decrease resistance to chemotherapy drugs.
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.
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.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about childhood acute myeloid leukemia, call the National Cancer
Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615. By dialing this toll-free number, you can speak with someone who can
answer your questions.
The Cancer Information Service can also send you booklets. The following booklets about
leukemia may be helpful to you:
- What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation
The following booklets on childhood cancer may also be helpful to you:
- Young People with Cancer: A Handbook for Parents
Talking with Your Child About Cancer
When Someone in Your Family Has Cancer
Managing Your Child's Eating Problems During Cancer Treatment
The following general booklets related to questions on cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
There are many other places you can get material about cancer treatment and services to
help you. You can check the social service office at your hospital for local and national
agencies that help with your finances, getting to and from treatment, care at home, and
dealing with your problems.
You can also write to the National Cancer Institute at this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 04/98
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
Source: National Cancer Institute
National Institutes of Health
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