Acute myeloid leukaemia (paediatric)

AML is when too many immature myeloid blood cells (blasts) are produced in the bone marrow. These are abnormal cells that do not mature into healthy white blood cells.

In this section

There are various types of AML depending on which type of cell is affected and how differentiated (well developed) the cell is. They are all treated in the same way except for one type called acute promyelocytic leukaemia (APL).

Who gets acute myeloid leukaemia?

AML is diagnosed in about 100 children in the UK each year. It can occur at any age and boys and girls are equally affected.

Some children with a genetic disorder, such as Down’s syndrome or Li-Fraumeni syndrome, have an increased risk of developing leukaemia. Rare conditions, such as aplastic anaemia or myelodysplasia, are also associated with an increased risk of leukaemia. There is no evidence to suggest a link between nuclear power plants or high voltage lines.

Signs and symptoms

Many of the symptoms are related to the fact that the leukaemia cells multiply in the bone marrow and stop the production of healthy blood cells. Common symptoms include:

  • tiredness
  • lethargy
  • pallor
  • bruising
  • fever and infection
  • swollen glands
  • limb pains.

Tests / investigations

We will need to carry out some tests to find out as much as possible about the type of leukaemia. This will help us to decide on the best treatment for your child. These tests include:

  • Blood tests – this will tell us if there are any leukaemia cells in the bloodstream and how the other blood cells are affected.
  • Chest X-ray – this will tell us whether any of the lymph glands in the chest are enlarged.
  • Bone marrow aspirate and trephine – these tests tell us exactly what type of AML your child has. We can look at features of the leukaemia cells, such as chromosome changes, which may help us to decide on the best treatment.
  • Lumbar puncture – this is to see whether there are any leukaemia cells in the spinal fluid. Your child will also need some anti-cancer drugs injected directly into the spinal fluid as part of the treatment.

Treatment of acute myeloid leukaemia

Acute myeloid leukaemia (AML) needs intensive treatment with chemotherapy and in some cases a bone marrow transplant. These are the different phases of treatment:

Induction

This consists of two courses of chemotherapy given about four weeks apart. The aim is to destroy as many leukaemia cells as possible. Response to the induction will be checked by examining the bone marrow after each course. The aim is for there to be no evidence of leukaemia in your child’s bone marrow after induction is completed (remission).

Post-remission therapy

Further chemotherapy is given to destroy any leukaemia cells that may be left and prevent the leukaemia coming back.

Bone marrow transplant

This is reserved for those children who don’t do so well with standard chemotherapy or if the leukaemia comes back. The chromosomes and response after the first course of induction chemotherapy help your medical team to decide whether your child needs a bone marrow transplant. About 20% of children will need a transplant as part of their first lot of treatment.

Central nervous system (CNS)

AML may sometimes develop around the brain and spinal cord. This can be prevented by injecting anti-cancer drugs directly into the spinal fluid (intrathecal chemotherapy) during a lumbar puncture.

Clinical trials

Clinical trials are medical research trials involving patients that are carried out to try and find new and better treatments. In cancer, clinical trials are most commonly used to try and improve different forms of treatment such as surgery, radiotherapy or chemotherapy.

The treatment being tested may be aimed at:

  • improving the number of people cured (for example: trying new types of surgery or chemotherapy)
  • improving survival
  • relieving the symptoms of the cancer
  • relieving the side effects of treatment
  • improving the quality of life or sense of well-being for people with cancer.

Clinical trials may also involve research aimed at understanding more about the tumour’s biology. You may be asked to allow us to do research on the tumour sample removed at surgery, or on blood samples.

Well-run clinical trials have led to a significant improvement in the treatment of children with cancer. If you are asked to consider entering your child into a clinical trial you will be given specific information about the trial before deciding whether to take part.

Effects of treatment

Many children with acute myeloid leukaemia (AML) are now cured with current treatment. However, the prognosis depends on how well your child responds to treatment and some of the features of the leukaemic cells such as the chromosomes.

General side effects of chemotherapy

Bone marrow suppression (myelosuppression)

Chemotherapy drugs decrease the production of blood cells by the bone marrow for a variable period of time. This results in low red blood cells (anaemia), low white blood cells (neutropenia) and platelets (thrombocytopenia). Your child may need blood or platelet transfusions and will be at increased risk of infections. The doctors and nurses caring for your child will tell you more about these side effects.

Nausea and vomiting

Some of the chemotherapy drugs used may make your child feel sick or vomit. We will give anti-sickness drugs at the same time to stop nausea and vomiting. These are usually very effective.

Sore mouth (mucositis)

Some of the chemotherapy drugs make the lining of the mouth and throat very sore and ulcerated. We will give your child painkillers for this, and explain how to care for your child’s mouth during treatment.

Hair loss

Temporary hair loss is common.

Specific drugs

For details of the side effects of individual drugs please see Macmillan specific drug information leaflets.

What are the possible long-term effects of treatment?

A small number of children may develop long-term side effects related to the treatment. These include reduced fertility, impaired heart function and a small increased risk of a second cancer in later life.

Once treatment has finished we will continue to see your child in the outpatient department. There are doctors available who can help us to treat any long-term effects.