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Acute Myeloid Leukemia (AML)

What Is Leukemia?

Leukemia is a type of blood cancer that affects the body's white blood cells (WBCs).

Normally, WBCs help fight infection and protect the body against disease. But in leukemia, white blood cells turn cancerous and multiply when they shouldn't. The result is too many abnormal WBCs, which then interfere with the body's ability to work as it should.

What Is Acute Myeloid Leukemia?

In acute myeloid leukemia (AML), the body makes too many immature white blood cells (called myeloid blasts). These abnormal leukemia cells can't mature into normal white blood cells.

AML has eight different subtypes, based on a cytologic (or cellular) system.

Of kids who have leukemia, 20% have AML. Thanks to advances in therapy and clinical trials, the outlook for kids with AML has improved. With treatment, most are cured.

What Causes Acute Myeloid Leukemia?

The cause of AML is unknown. Some medical conditions can increase a child's risk of getting it. But just having a risk factor doesn't mean that a child will get AML.

Who Gets Acute Myeloid Leukemia?

Risks factors for kids include:

  • inherited genetic problems such as Down syndrome, neurofibromatosis type 1, Fanconi anemia, Noonan syndrome, and other inherited bone marrow failure syndromes (IBMFS)
  • non-inherited conditions such as preleukemia (also called myelodysplastic syndrome, or MDS) and aplastic anemia
  • prior radiation treatment or chemotherapy for other types of cancer (AML is the most common type of secondary cancer in children who have previously had cancer treatment)
  • exposure to X-rays before birth
  • having an identical twin who was diagnosed with the illness before age 6
  • being a fraternal twin and other sibling of a child with leukemia

Environmental factors sometimes can put a child at risk for leukemia. For example, exposure to radiation (such as X-rays) before birth may trigger the disease in a developing fetus.

What Are the Signs & Symptoms of Acute Myeloid Leukemia?

Chronic leukemia develops slowly, and early symptoms may be mild. Acute leukemia develops quickly, and the cancerous cells multiply fast. That's why AML tends to get worse quickly if it's not treated.

The symptoms of all types of leukemia are generally the same and include:

  • being very tired, weak, or pale
  • swollen lymph nodes
  • infections (like bronchitis or tonsillitis) that keep coming back
  • a fever
  • night sweats
  • easy bruising or petechiae (tiny red spots on the skin caused by easy bleeding)
  • bone and joint pain
  • abdominal pain (caused by abnormal blood cells building up in organs like the kidneys, liver, and spleen)

Sometimes a child might have painless lumps that can be felt in the lymph nodes of the neck, underarm, or groin area. These lumps of leukemia cells (called chloromas) can develop anywhere in the body.

How Is Acute Myeloid Leukemia Diagnosed?

If a doctor suspects leukemia, a child may have these tests:

  • Blood tests. Tests such as a complete blood count, liver function and kidney function panels, and blood chemistries can give important information about the number of normal blood cells in the body and how well the organs are working. The blood cells are examined under a microscope to check for abnormal shapes or sizes, and see which subtype of AML a child has.
  • Bone marrow aspiration and biopsy. In this procedure, the doctor inserts a needle into a large bone, usually the hip, and removes a small amount of bone marrow to examine it for abnormal cells.
  • Imaging studies. These may include an X-ray, CT scan, MRI, or ultrasound to check for an enlarged spleen or liver, and to rule out any other possible causes of a child's symptoms.
  • Lumbar puncture. Also called a spinal tap, this procedure uses a hollow needle to remove a small amount of cerebrospinal fluid (CSF, the fluid surrounding the brain and spinal cord) for examination in a lab.
  • Flow cytometry tests. Using markers on leukemia cells collected from the blood, bone marrow, and/or CSF, doctors can determine the subtype of leukemia a child has. This is important because treatments vary among different types of leukemia.
  • Chromosomal tests. By analyzing DNA from blood or bone marrow, doctors can check for the specific genetic changes that identify the various subtypes of AML. Treatment may vary depending on which AML subtype a child has.
  • Tissue typing or HLA (human leukocyte antigen) typing. If a child needs a stem cell transplant (also called a bone marrow transplant), this test helps doctors find a suitable stem cell donor.

How Is Acute Myeloid Leukemia Treated?

Because it can progress so quickly, there is no staging system for AML. Doctors generally characterize the disease as newly diagnosed or in remission.

Treatment is divided into two phases:

The goal of the first phase, called induction, is to kill as many cancer cells as possible and achieve remission (a state where there is no evidence of disease in the body).

The second phase — called post-remission, consolidation, or continuation therapy — is designed to eliminate any undetectable leukemia cells to prevent the leukemia from coming back.

Both phases of treatment may include these therapies alone or in combination:

  • Chemotherapy. This is the use of special drugs to kill the cancer cells. Often, several drugs are combined to attack the cancer cells in different ways.
  • Chemotherapy through lumbar puncture. This procedure, known as intrathecal (IT) chemotherapy, delivers the drugs directly to the cerebrospinal fluid, where cancerous cells can collect.
  • All-trans retinoic acid (ATRA). This vitamin A treatment is sometimes given along with chemo to kids with acute promyelocytic leukemia (APL), a subtype of AML.
  • Arsenic trioxide. This substance (an inorganic compound) is also used to treat kids with APL.
  • Stem cell transplant (also called bone marrow transplant). This procedure involves destroying cancer cells and normal bone marrow and immune system cells with high-dose chemotherapy and then reintroducing healthy donor stem cells into the body. These new stem cells can rebuild a healthy blood supply and immune system.
  • Clinical trials. These are research studies that offer promising new treatments that are not yet available to the general public. Doctors will decide if a child is a good candidate for a clinical trial.

Looking Ahead

Being told that a child has cancer can be terrifying, and the stress of cancer treatment can feel overwhelming for any family.

Although you might feel like it at times, you're not alone. To find support that might help you or your child, talk to your doctor or a hospital social worker. Many resources are available to help you get through this difficult time.

Reviewed by: Emi H. Caywood, MD
Date reviewed: October 2017
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