Acute Myeloid Leukemia—Child

Leukemia is a type of cancer that develops in the bone marrow. With acute myeloid leukemia (AML), the bone marrow makes abnormal myeloid cells that are precursors to blood cells, including:

• Myeloblasts (a type of white blood cell) that fight infection
• Platelets that make blood clots and stop bleeding in cuts and bruises
• Red blood cells that carry oxygen

The leukemia cells do not function normally. They cannot do what normal blood cells do, like fight infections. The abnormal cells also overgrow the bone marrow, forcing normal cells out. Without normal cells, anemia and bleeding problems develop. They also cannot fight infections properly.

Leukemia is caused by genes in the bone marrow cells not working properly.

Risk factors include:

• Exposure to radiation
• Genetic factors
  • Having a genetic condition (eg, Down syndrome )
  • Having a sibling, especially an identical twin, who develops leukemia
• History of other blood disorders (eg, polycythemia vera , essential thrombocytosis, myelodysplastic syndrome
• Exposure to certain chemicals (eg, benzene, a chemical used in the cleaning and manufacturing industries)
• Race: Hispanic

Symptoms include:

• Bleeding gums
• Bone and joint pain
• Easy bruising or bleeding
• Fever
• Frequent infections
• Loss of appetite, weight loss
• Painless lumps in the neck, underarms, stomach, or groin
• Paleness (a sign of anemia)
• Petechiae (flat, pinpoint spots under the skin caused by bleeding)
• Shortness of breath
• Weakness, fatigue

These symptoms may be due to other conditions. If your child has any of these, talk to the doctor.

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. The doctor will check for swelling of the liver, spleen, and lymph nodes. Tests may include:

• Gallium scan and bone scan —injection of a radioactive chemical into the bloodstream to detect areas of cancer or infection
• Blood tests—to check for changes in the number or appearance of different types of blood cells
• Bone marrow biopsy or aspiration—removal of a sample of liquid bone marrow and a small piece of bone to test for cancer cells
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
• Chest x-ray —x-rays of the chest that may detect signs of lung infection or cancer in the chest
• Cytogenetic analysis—a test to look for certain changes in the chromosomes (genetic material) of the lymphocytes
• Immunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body
• Lumbar puncture (spinal tap)—removal of a small amount of cerebrospinal fluid to check for cancer cells
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
• Ultrasound—a test that uses sound waves to examine masses and organs inside the body

Once AML is identified, it can be classified. These subtypes are based on the type of cell from which leukemia developed. This is important because it can help the doctor make a prognosis and develop a treatment plan.

Talk with the doctor about the best plan for your child. Treatment of AML usually involves two phases:

• Maintenance therapy—to kill any remaining leukemia cells that could grow and cause a relapse
• Remission induction therapy—to kill leukemia cells

Treatment options include:

• Antibiotics to treat and prevent infections
• Biological therapy—involves using medicine or substances made by the body to increase or restore the body’s natural defenses against cancer
• Chemotherapy
• External beam radiation therapy—targets a certain part of the body
• Medicines to treat anemia and side effects (like nausea and vomiting)
• Other drug therapy (eg, arsenic trioxide, All-trans retinoic acid [ATRA])—may be used to kill leukemia cells, stop them from dividing, or help them mature into white blood cells
• Stem cell transplant —replaces the affected bone marrow with healthy bone marrow

There is no known way to prevent AML.