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Acute Myeloid Leukemia—Child by Krisha McCoy, MS Rebecca J. Stahl, MA

Definition

Leukemia is a type of cancer that develops in the bone marrow. With acute myeloid leukemia (AML), the bone marrow makes abnormal myeloid cells that are precursors to blood cells, including:

Myeloblasts (a type of white blood cell) that fight infection
Red blood cells that carry oxygen
Platelets that make blood clots and stop bleeding in cuts and bruises

The leukemia cells do not function normally. They cannot do what normal blood cells do, like fight infections. The abnormal cells also overgrow the bone marrow, forcing normal cells out. Without normal cells, anemia and bleeding problems develop. They also cannot fight infections properly.

Causes

Leukemia is caused by genes in the bone marrow cells not working properly.

Risk Factors

Risk factors include:

Genetic factors
- Having a sibling, especially an identical twin, who develops leukemia
- Having a genetic condition (eg, Down syndrome )
Exposure to radiation
Exposure to certain chemicals (eg, benzene, a chemical used in the cleaning and manufacturing industries)
History of other blood disorders (eg, polycythemia vera , essential thrombocytosis, myelodysplastic syndrome
Race: Hispanic

Symptoms

Symptoms include:

Fever
Frequent infections
Shortness of breath
Paleness (a sign of anemia)
Easy bruising or bleeding
Petechiae (flat, pinpoint spots under the skin caused by bleeding)
Weakness, fatigue
Loss of appetite, weight loss
Bone and joint pain
Painless lumps in the neck, underarms, stomach, or groin
Bleeding gums

These symptoms may be due to other conditions. If your child has any of these, talk to the doctor.

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. The doctor will check for swelling of the liver, spleen, and lymph nodes. Tests may include:

Blood tests—to check for changes in the number or appearance of different types of blood cells
Bone marrow biopsy or aspiration—removal of a sample of liquid bone marrow and a small piece of bone to test for cancer cells
Lumbar puncture (spinal tap)—removal of a small amount of cerebrospinal fluid to check for cancer cells
Cytogenetic analysis—a test to look for certain changes in the chromosomes (genetic material) of the lymphocytes
Immunophenotyping—examination of the proteins on cell surfaces and the antibodies produced by the body
Chest x-ray —x-rays of the chest that may detect signs of lung infection or cancer in the chest
CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body
MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
Gallium scan and bone scan —injection of a radioactive chemical into the bloodstream to detect areas of cancer or infection
Ultrasound—a test that uses sound waves to examine masses and organs inside the body

Once AML is identified, it can be classified. These subtypes are based on the type of cell from which leukemia developed. This is important because it can help the doctor make a prognosis and develop a treatment plan.

Bone Marrow Biopsy

Treatment

Talk with the doctor about the best plan for your child. Treatment of AML usually involves two phases:

Remission induction therapy—to kill leukemia cells
Maintenance therapy—to kill any remaining leukemia cells that could grow and cause a relapse

Treatment options include:

Chemotherapy
External beam radiation therapy—targets a certain part of the body
Stem cell transplant —replaces the affected bone marrow with healthy bone marrow
Other drug therapy (eg, arsenic trioxide, All-trans retinoic acid [ATRA])—may be used to kill leukemia cells, stop them from dividing, or help them mature into white blood cells
Biological therapy—involves using medicine or substances made by the body to increase or restore the body’s natural defenses against cancer
Antibiotics to treat and prevent infections
Medicines to treat anemia and side effects (like nausea and vomiting)

Prevention

There is no known way to prevent AML.

RESOURCES:

American Cancer Society http://www.cancer.org/
National Cancer Institute http://www.cancer.gov/

CANADIAN RESOURCES:

BC Cancer Agency http://www.bccancer.bc.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html/

References:

American Cancer Society. Leukemia in children detailed guide. American Cancer Society website. Available at: http://www.cancer.org/Cancer/LeukemiainChildren/DetailedGuide/index . Accessed July 13, 2010.
Children’s Hospital Boston. Leukemia. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1236/mainpageS1236P0.html . Accessed July 13, 2010.
DynaMed Editorial Team. Acute myeloid leukemia (AML). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated July 13, 2010. Accessed July 14, 2010.
Mayo Clinic. Acute myelogenous leukemia. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/acute-myelogenous-leukemia/DS00548 . Updated July 8, 2010. Accessed July 14, 2010.
McCoy K. Acute myelogenous leukemia. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated June 25, 2010. Accessed July 14, 2010.

Last reviewed June 2012 by Kari Kassir, MD

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Acute Myeloid Leukemia—Child by Krisha McCoy, MSRebecca J. Stahl, MA