Acute Myeloid Leukemia (AML)

Acute myeloid leukemia (AML) is a fast-growing cancer of the blood and bone marrow. In children it accounts for about one in five leukemias. It starts in young myeloid cells that would normally become red blood cells, platelets and infection-fighting white cells.

Our pediatric team treats children in a child-friendly environment, with support for parents, siblings and schooling throughout treatment.

Signs and symptoms

• Tiredness, pale skin and breathlessness
• Fever and repeated infections
• Easy bruising, nosebleeds, bleeding gums or tiny red spots on the skin
• Bone or joint pain; a child may limp or refuse to walk
• Swollen gums or lumps under the skin (in some subtypes)
• A swollen tummy from an enlarged liver or spleen

Causes and risk factors

In most children no cause is found and nothing the family did caused the leukemia. The risk is higher in children with:

• Down syndrome
• Inherited bone marrow failure syndromes such as Fanconi anemia
• Previous chemotherapy or radiation therapy
• An identical twin who developed leukemia

Outlook

With modern intensive treatment and excellent supportive care, a majority of children with AML are cured. Children with Down syndrome and those with acute promyelocytic leukemia (APL) have particularly good results with specially adapted treatment.

We use gentle, child-friendly approaches — including sedation for procedures — to confirm AML and find the genetic features that decide treatment.

Complete blood count (CBC) and peripheral blood smear

Shows low normal blood cells and leukemic blasts. Clotting tests check for bleeding problems.

Bone marrow aspiration and biopsy

Performed under sedation or general anesthesia. Confirms the diagnosis and the proportion of blasts.

Lumbar puncture

Checks the spinal fluid for leukemia cells; chemotherapy can be given into the fluid at the same time.

Cytochemistry

Special stains show features that distinguish AML from ALL.

Flow cytometry and immunohistochemistry

Identify the markers on the leukemia cells and the AML subtype.

Chromosome tests and FISH

Find changes such as t(8;21), inv(16), t(15;17) or KMT2A rearrangements that place a child in a low-, standard- or high-risk group.

Molecular tests

Look for mutations such as FLT3-ITD and NPM1.

Imaging tests

Chest X-ray, ultrasound and an echocardiogram (heart scan) before treatment.

Childhood AML is treated with intensive chemotherapy given in hospital, combined with targeted drugs and transplant for higher-risk disease.

Chemotherapy

Usually four or five courses: induction to achieve remission, followed by intensification courses. Chemotherapy into the spinal fluid protects the brain.

Targeted therapy

• Gemtuzumab ozogamicin for CD33-positive AML
• FLT3 inhibitors for FLT3-mutated AML
• All-trans retinoic acid (ATRA) and arsenic trioxide for APL, usually without intensive chemotherapy

Radiation therapy

Rarely needed — for leukemia in the brain that does not respond, or a localized leukemia mass (chloroma).

Bone marrow / stem cell transplant

An allogeneic stem cell transplant in first remission is recommended for high-risk AML or when residual disease remains after induction. Siblings are HLA-typed early, and unrelated or haploidentical donors are used when no sibling matches.

Supportive care

Infection prevention, transfusions, nutrition, pain control, play therapy and psychosocial support for the whole family.

Our pediatric hemato-oncologists and transplant physicians care for children with AML and their families.