test About Medicine OnLine Medicine OnLine Home Page Cancer Libraries DoseCalc Online Oncology News
Cancer Forums Medline Search Cancer Links Glossary



National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Childhood acute myeloid leukemia


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is childhood acute myeloid leukemia?
STAGE EXPLANATION
Stages of childhood acute myeloid leukemia
Untreated
In remission
Recurrent/refractory
TREATMENT OPTION OVERVIEW
How childhood acute myeloid leukemia (AML) is treated
Treatment by stage
UNTREATED CHILDHOOD ACUTE MYELOID LEUKEMIA
CHILDHOOD ACUTE MYELOID LEUKEMIA IN REMISSION
RECURRENT CHILDHOOD ACUTE MYELOID LEUKEMIA
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that provides up-to-date information on cancer and its prevention, detection, treatment, and supportive care. PDQ is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

Cancer in children and adolescents is rare. The majority of children with cancer are treated at cancer centers with special facilities to treat childhood cancers. There are organized groups of doctors and other health care professionals who work together by doing clinical trials to improve treatments for children with cancer.

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your child's doctor, who knows your child and has the facts about your child's disease. PDQ can also provide the names of additional health care professionals and hospitals that specialize in treating children who have cancer.

Before your child begins treatment, you may want to consider entering your child in a clinical trial. PDQ can be used to learn more about the trials. A clinical trial is a research study that attempts to improve current treatments or find new treatments for people with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers specific scientific questions in order to find new and better ways to help people with cancer. During clinical trials, information is collected about new treatments, their risks, and how well they do or do not work. When a clinical trial shows that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the "standard" treatment. Children who are treated in clinical trials have the advantage of getting the best available therapy. In the United States, about two thirds of children with cancer are treated in a clinical trial at some point in their illness.

Listings of current clinical trials are available on PDQ. In the United States, there are two major groups (called cooperative groups) that organize clinical trials for childhood cancers: the Childrens Cancer Group (CCG) and the Pediatric Oncology Group (POG). Doctors who belong to these groups or who take part in other clinical trials are listed in PDQ.

To learn more about cancer and how it is treated or to learn more about clinical trials for your child's kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer your cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is childhood acute myeloid leukemia?

Childhood acute myeloid leukemia (AML) is a cancer of the blood-forming tissue, primarily the bone marrow and lymph nodes. AML is also called acute nonlymphocytic leukemia or acute myelogenous leukemia, and is divided into several subtypes. It is less common than acute lymphocytic leukemia (also called acute lymphoblastic leukemia or ALL), another form of leukemia that occurs in children. Children with Down syndrome have an increased risk of AML during the first 3 years of life.

All types of blood cells are produced by the bone marrow. The bone marrow is the spongy tissue inside the large bones of the body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which help make the blood clot).

The bone marrow controls the production of normal cells. In leukemia, the production process breaks down and the bone marrow starts producing large numbers of abnormal cells of only one cell type, usually one of the white cells. These abnormal, immature cells, called blasts, then flood the blood stream and lymph system, and may invade vital organs such as the brain, testes, ovaries, or skin. In rare cases, AML tumor cells appear as a solid tumor called an isolated granulocytic sarcoma or chloroma.

Leukemia can be acute (progressing quickly with many immature blasts) or chronic (progressing slowly with more mature-looking cancer cells). Acute myeloid leukemia can occur in both children and adults. Treatment is different for adults than it is for children. For information about the treatment of adult AML, see the PDQ patient information summary on adult acute myeloid leukemia. Separate PDQ information summaries are also available for chronic lymphocytic leukemia, chronic myelogenous leukemia, adult and childhood acute lymphocytic leukemia, and hairy cell leukemia.

Early signs of AML may be fever, chills, bleeding or bruising easily, swollen lymph nodes, and other symptoms similar to those of the flu, such as feeling weak or tired all the time and aching bones or joints. If your child has symptoms of leukemia, his or her doctor may order a blood test to count the number of cells and examine them under a microscope. If the results of the blood tests are not normal, a bone marrow biopsy may be performed. During this test, a needle is inserted into a bone in the hip and a small amount of bone marrow is removed and examined under a microscope, enabling the doctor to determine what kind of leukemia your child has and plan the best treatment. Chromosomal analysis may also be performed. These additional tests can help distinguish AML from ALL and other leukemias and allow doctors to better plan treatment.


STAGE EXPLANATION


Stages of childhood acute myeloid leukemia

There is no staging for acute myeloid leukemia (AML). AML is always spread throughout the bloodstream at the time of diagnosis, and sometimes invades other body tissue. Patients are often grouped according to whether or not they have been previously treated for leukemia.


Untreated

Untreated AML means that no treatment has yet been given except to alleviate or treat symptoms of the disease. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia. In rare cases, AML tumor cells appear as a solid tumor called an isolated granulocytic sarcoma or chloroma.


In remission

Remission means that the numbers of white blood cells and other cells in the blood and bone marrow are approaching normal following initial treatment with chemotherapy and that there are no signs or symptoms of leukemia.


Recurrent/refractory

Recurrent means that the leukemia has come back (recurred) after going into remission. Refractory means that the leukemia failed to go into remission following treatment.


TREATMENT OPTION OVERVIEW


How childhood acute myeloid leukemia (AML) is treated

There are treatments for all patients with childhood acute myeloid leukemia (AML). Experienced doctors working together may provide the best treatment for children with AML. Your child's treatment will often be planned by a team of childhood cancer specialists with experience and expertise in treating leukemias of childhood.

The primary treatment for AML is chemotherapy, sometimes followed by bone marrow transplantation. Radiation therapy may be used in certain cases. Biological therapy is also being studied in clinical trials.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs may be taken by mouth or injected into a vein (intravenous injection) or a muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy may sometimes be injected into the fluid that surrounds the brain and spinal cord (intrathecal chemotherapy).

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for AML usually comes from a machine outside the body (external radiation therapy).

Bone marrow transplantation, a newer type of treatment, is used to replace the patient's bone marrow with healthy bone marrow. First, high doses of chemotherapy with or without radiation therapy are given to destroy all of the bone marrow in the body. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or another person not related. The healthy marrow from the donor is given to the patient through a needle in a vein, and the healthy marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or person not related is called an allogeneic bone marrow transplant.

Another type of bone marrow transplant, called autologous bone marrow transplant, may be used. During this procedure, bone marrow is taken from the patient and may be treated with drugs to kill any cancer cells. The marrow is then frozen to save it. Next, the patient is given high-dose chemotherapy, with or without radiation therapy, to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and returned to the patient to replace the marrow that was destroyed.

Biological therapy attempts to stimulate or restore the ability of the patient's immune system to fight cancer. It uses substances produced by the patient's own body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier therapy or immunotherapy.

Treatment for AML is ordinarily divided into 2 phases: induction and consolidation. A third phase, intensification, may also be used. During induction therapy, chemotherapy is used to kill as many of the leukemia cells as possible and cause the leukemia to go into remission. Once the leukemia goes into remission and there are no signs of leukemia, consolidation therapy is given. The purpose of postremission therapy (consolidation and intensification) is to kill any remaining leukemia cells. Your child may receive either or both phases of postremission therapy.

As preventive therapy, your child may also receive central nervous system (CNS) prophylaxis, which consists of intrathecal and/or high-dose systemic chemotherapy to the central nervous system (CNS) to kill any leukemia cells present there, or to prevent the spread of cancer cells to the brain and spinal cord even if no cancer has been detected there. Radiation therapy to the brain may also be given, in addition to chemotherapy, for this purpose.

Unwanted side-effects can result from treatment long after it ends, so it is important that your child continue to be seen by his or her doctor. Chemotherapy can lead to heart, kidney, and hearing problems after treatment is finished. Radiation therapy may cause problems with growth and development.


Treatment by stage

Treatment for childhood AML depends on whether or not the patient has been previously treated for leukemia and the type of leukemia. The best treatment is given by cancer doctors with experience in treating children with leukemia, and is given at hospitals where leukemia patients are often treated.

Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child take part in a clinical trial. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients, and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most types of childhood AML. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


UNTREATED CHILDHOOD ACUTE MYELOID LEUKEMIA

Your child's treatment will probably be induction chemotherapy using 2 or more chemotherapy drugs to kill cancer cells and cause the leukemia to go into remission. Induction chemotherapy is usually successful in inducing remission. Intrathecal chemotherapy with or without radiation therapy to the brain may be given to prevent the spread of cancer cells to the brain and spinal cord. Biological therapy may be added to treatment to help your child recover more quickly from the side effects of induction therapy.


CHILDHOOD ACUTE MYELOID LEUKEMIA IN REMISSION

Treatment will consist of additional chemotherapy or bone marrow transplantation. Central nervous system prophylaxis and/or maintenance chemotherapy may also be given in some cases.


RECURRENT CHILDHOOD ACUTE MYELOID LEUKEMIA

Treatment depends on the type of treatment your child received before. You may want to consider entering your child into a clinical trial. Treatments currently being studied in clinical trials include new chemotherapy drugs, bone marrow transplantation, and biological therapy.

Unwanted side effects can result from treatment long after it ends, so it is important that your child continue to be seen by his or her doctor. Chemotherapy can later lead to heart problems, as well as kidney and hearing problems. Radiation therapy may interfere with a child's growth and may increase the risk of hormonal dysfunction and cataract formation.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about childhood acute myeloid leukemia, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is toll-free and a trained information specialist can answer your questions.

The Cancer Information Service can also send you booklets. The following booklets about leukemia may be helpful to you:

What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation

The following booklets on childhood cancer may also be helpful to you:

Young People with Cancer: A Handbook for Parents
Talking with Your Child About Cancer
When Someone in Your Family Has Cancer
Managing Your Child's Eating Problems During Cancer Treatment

The following general booklets related to questions on cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment

There are many other places where material about cancer treatment and information about services are available. Check the hospital social service office for local and national agencies that help with finances, getting to and from treatment, care at home, and dealing with other problems.

Write to the National Cancer Institute at this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 09/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


Home | 

test About Medicine OnLine Medicine OnLine Home Page Cancer Libraries DoseCalc Online Oncology News
Cancer Forums Medline Search Cancer Links Glossary