What is acute myeloid leukemia (AML)?
Acute myeloid leukemia (AML) is a cancer that involves a type of white cell in the bone marrow. The condition develops in the bone marrow, where the body's blood cells are made. The malignant cells in AML are immature, myeloid blood cells. Normal myeloid cells mature into white cells, red cells, and platelets. In AML, the myeloid cells somehow escape the normal controls that direct their maturing into normal blood cells. These immature cells are called blasts.
Acute myeloid leukemia can occur in all ages. The cause of AML is not known, but it is not hereditary nor is it contagious. Possible factors that are currently being researched include environment and genetics.
As the leukemic blast cells accumulate in the bone marrow, they begin to crowd out the normal cells that develop there. Eventually, they occupy so much room that red blood cells, platelets, and normal white blood cells cannot be produced. When this happens, a child develops symptoms indicating normal blood cells are not being manufactured in adequate numbers.
What are the symptoms of AML?
When red blood cells are crowded out, the hemoglobin will drop. The child may look pale and feel tired and irritable. When platelets are low, the child may bruise more easily and have bleeding problems such as bleeding gums, or nose bleeds. When normal, mature white blood cells are crowded out, no cells remain to fight bacteria and infections may occur. The accumulation of blasts in the bone marrow can also cause increased pressure and result in bone pain.
The leukemic cells can "spill out" from the bone marrow and travel anywhere in the body that blood goes. They can spread or travel to the lymph nodes, spleen and liver, which may cause these organs to become enlarged. Leukemic cells can also spread into the spinal fluid that surrounds the spinal cord and brain. Sometimes leukemia cells collect in the skin tissue. These are called myeloid sarcomas.
How is AML diagnosed?
To diagnosed AML, your doctor takes a history of your child's symptoms, performs a physical examination, and completes a microscopic examination of your child's blood cells, bone marrow cells and spinal fluid.
A bone marrow aspiration/biopsy is obtained by inserting a needle into the hipbone and removing some marrow cells to test under the microscope. Leukemia starts here and this test established the diagnosis. A lumbar puncture, also called a spinal tap, is when a needle is inserted into the spinal canal and spinal fluid is removed and tested for leukemia cells. These tests are done under sedation or general anesthesia.
How is AML treated?
The treatment of AML is the administration of chemotherapy (cancer-fighting drugs). Chemotherapy will be given in two phases.
The first phase is called induction, during which high doses of chemotherapy are given. The purpose of this phase is to induce a remission by killing leukemia cells as quickly as possible. Your child will need to be in the hospital during chemotherapy. Bone marrow tests will be done three to five weeks into treatment to determine when a remission is achieved. Cycles of induction chemotherapy are repeated twice. It can take the patient three to five weeks to recover from each cycle of induction chemotherapy. Patients must remain in the hospital during their recovery until their blood counts recover.
The next phase of treatment is called intensification. The goal is to solidify remission through intensive chemotherapy drugs. More chemotherapy is given in the hospital and again patients must stay in the hospital to recover. There are three treatment cycles during intensification. Children with acute myeloid leukemia who have a sibling donor may have a bone marrow transplant after one cycle of intensification as part of their treatment. Your physician will discuss this possibility with you. Recovery after each cycle is about three to five weeks. Patients must remain in the hospital during their recovery until their blood counts recover.
Following completion of chemotherapy, your child will be followed with routine visits in the clinic. Blood tests will be done periodically to be sure your child's leukemia remains in remission.
About treatment for AML at Children's
Children's hematology/oncology program consistently achieves treatment results ranking it as one of the top 10 programs in the U.S. Children's treats the majority of children with cancer and blood disorders in Minnesota and provides patients with access to a variety of clinical trials of groundbreaking new treatments. Through our renowned leukemia/lymphoma program, patients experience unparalleled family support, a nationally renowned pain management team, and compassionate, coordinated care.
If you are a family member looking for a Children's hematologist or oncologist or wanting to schedule an appointment, please call our clinic at Children's – Minneapolis at (612) 813-5940.
If you are a health professional looking for consultation or referral information, please call Children's Physician Access at 1-866-755-2121 (toll-free) and ask for the on-call hematologist/oncologist.