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Together is a new resource for anyone affected by pediatric cancer - patients and their parents, family members, and friends.
Learn MoreAcute myeloid leukemia (AML) is a cancer of the blood and bone marrow. AML is the second most common childhood leukemia after acute lymphoblastic leukemia (ALL).
About 500 children are found to have AML in the U.S. each year. It is much more common in adults.
Childhood AML is most common during the first 2 years of life and during the teenage years.
AML affects blood cells called myeloid stem cells. Normally, the bone marrow makes blood-producing stem cells that either become myeloid stem cells or lymphoid stem cells. A myeloid stem cell becomes one of three types of mature blood cells:
Learn more about leukemia and lymphoma causes, treatment, and side effects.
This image shows how normal, healthy bone marrow appears through a microscope.
This is the bone marrow of a pediatric patient with acute myeloid leukemia.
In leukemia, cancer cells grow rapidly in the bone marrow. These cancer cells are immature white blood cells called blasts. When this happens, healthy blood cells — white blood cells, red blood cells, and platelets — can’t do their jobs correctly.
AML affects blood cells called myeloid stem cells. Normally, the bone marrow makes blood-producing stem cells that either become myeloid stem cells or lymphoid stem cells.
AML affects blood cells called myeloid stem cells. Normally, the bone marrow makes blood-producing stem cells that either become myeloid stem cells or lymphoid stem cells. A myeloid stem cell becomes one of three types of mature blood cells:
Risk factors for childhood AML include having:
Having certain inherited disorders, such as:
In AML, signs and symptoms may include:
Bone marrow tests are usually required to diagnose leukemia. Doctors may begin to suspect leukemia after conducting a physical exam, taking a medical history, and looking at the results of blood tests. Children with leukemia usually have a high number of immature white blood cells in their blood.
Doctors will order a blood test called a complete blood count. A sample of blood is drawn and checked for the:
In leukemia, the blood may have a high number of white blood cells. Many of these cells can be blasts, an early form of cell that is usually found only in the bone marrow in healthy children.
A blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
Doctors may begin to suspect leukemia after conducting a physical exam, taking a medical history, and looking at the results of blood tests.
If cancer is determined, more tests will be performed to pinpoint the subtype of the cancer. These tests include:
Tests to determine if the cancer has spread include:
Treatment depends on the type of AML. Three forms of AML — acute promyelocytic leukemia (APL), AML in children with Down syndrome, and FLT3-mutated AML — are treated differently from other forms of AML.
Chemotherapy is the primary AML treatment. Bone marrow transplant may also be an option.
Doctors gather information to inform treatment.
The patient will undergo insertion of a tunneled central line or other central venous access device for delivery of chemotherapy, fluids, and to take blood samples.
The goal of this phase is destroy leukemia cells in the blood and bone marrow and bring the disease into remission.
Since AML patients are vulnerable to infection, supportive therapy with antibiotics is also given.
Central nervous system (CNS) sanctuary therapy (also called CNS prophylaxis) may also be given during this time to kill leukemia cells that remain in the brain and spinal cord.
Doctors will likely look at how well induction chemotherapy worked to decide if a hematopoietic cell transplant is needed. In fact, patients and families may undergo HLA typing to identify possible donors in case the patient needs to undergo a transplant.
Many pediatric centers use highly sensitive tests to measure for minimal residual disease (MRD). Positive MRD indicates a greater risk of relapse and need for more intensive therapy.
This consolidation phase begins after the patient is in remission. Its goal is to destroy any leukemia cells that may remain.
It includes 2-4 cycles of chemotherapy.
Some patients may receive a hematopoietic cell transplant at this stage. If a patient has a transplant, he or she will be hospitalized for several weeks. It will likely be a year before the patient can return to school.
The patient may return for follow-up visits once every 4 months.
These visits may include:
Follow-up visits may change to once every 6 months.
Follow-up visits may change to once a year.
The goal of the induction phase is to kill leukemia cells in the blood and bone marrow and bring the disease into remission. Since AML patients are vulnerable to infection, supportive therapy with antibiotics is also given.
Central nervous system (CNS) sanctuary therapy (also called CNS prophylaxis) may also be given during this time to kill leukemia cells that remain in the brain and spinal cord. Medications are injected into the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord (intrathecal).
Induction therapy typically includes a combination of drugs such as cytarabine and an anthracycline, most commonly daunorubicin. Etoposide, thioguanine, or gemtuzumab ozogamicin may also be given during induction therapy.
The goal of this phase is to kill any remaining leukemia cells that could grow and cause the cancer to relapse. Cancer centers can perform tests that can detect a single AML cell among 1,000 normal cells. Children who have more than one cell in 1,000 after completing the induction phase are at the greatest risk of relapsing.
This consolidation phase begins after the patient is in remission. It includes 2-4 cycles of chemotherapy and lasts for 4 to 6 months. Such therapy includes some of the drugs used in induction while also introducing non-cross–resistant drugs and commonly high-dose cytarabine.
A hematopoietic cell transplant (also known as a bone marrow transplant or stem cell transplant) may be recommended for children who are at high risk for relapse or whose AML is resistant to treatment. Doctors sometimes look at how well induction chemotherapy worked to decide whether a bone marrow transplant is needed.
AML patients may receive an allogeneic transplant.
In an allogeneic bone marrow transplant, children receive blood cell-producing cells from a healthy donor. Patients must have a suitable donor to be eligible for a transplant. Before receiving the donor cells, the patient’s existing blood cells in the bone marrow are destroyed by chemotherapy and sometimes radiation. The patient receives the healthy donor blood and marrow cells through an infusion. If successful, these new donor cells will grow into and replace the patient’s blood and marrow cells. As a result, the patient’s bone marrow should start to produce healthy blood cells.
The five-year survival rate for childhood AML is about 70 percent.
About 90 percent of children with AML have no cancer cells in their blood after initial treatment. About 30 percent of children with AML relapse or have disease that is resistant to treatment (refractory).
Some AML patients may have late effects. A late effect is a health problem that occurs months or years after treatment has ended.
Cancer patients should continue to be followed by their treatment center care team and/or a primary care provider in the community after cancer treatment. Late effects can often be treated or, in some cases, prevented.
Different treatments may have different late effects. Not all patients will have late effects. Patients who had the exact same treatment may experience different late effects.
AML patients may be at risk for:
Patients who undergo a hematopoietic cell transplant may be at risk for certain late effects.
Researchers are testing new drugs to treat AML. These include:
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Reviewed: June 2020