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CHILDHOOD ACUTE MYELOID LEUKEMIA

Childhood acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells.

Childhood acute myeloid leukemia usually gets worse quickly if it is not treated. Acute myeloid leukemia is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, or acute nonlymphocytic leukemia.

In AML, the myeloid stem cells usually develop into a type of immature white blood cell called myeloblasts (or myeloid blasts). The myeloblasts, or leukemia cells, in AML are abnormal and do not become healthy white blood cells. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur. The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums. Sometimes leukemia cells form a solid tumor called a granulocytic sarcoma or chloroma.

Risk factors for childhood AML

  • Having a brother or sister, especially a twin, with leukemia
  • Being Hispanic
  • Being exposed to cigarette smoke or alcohol before birth
  • Having a history of MDS (also called preleukemia) or aplastic anemia
  • Past treatment with chemotherapy or radiation therapy
  • Being exposed to ionizing radiation or chemicals such as benzene
  • Having certain genetic disorders, such as Down syndrome, Fanconi anemia, neurofibromatosis type 1, or Noonan syndrome

Symptoms of childhood AML

  • Fever with or without an infection
  • Night sweats
  • Shortness of breath
  • Weakness or feeling tired
  • Easy bruising or bleeding
  • Petechiae (flat, pinpoint spots under the skin caused by bleeding)
  • Pain in the bones or joints
  • Pain or feeling of fullness below the ribs
  • Painless lumps in the neck, underarm, stomach, groin, or other parts of the body. When seen in childhood AML, these lumps, called leukemia cutis, may be blue or purple
  • Painless lumps that are sometimes around the eyes. These lumps, called chloromas, are sometimes seen in childhood AML and may be blue-green
  • An eczema-like skin rash

Diagnostic tests and exams for childhood AML

  • Physical exam and history including checking for signs of disease, such as lumps or anything else that seems unusual
  • Blood test for complete blood count (CBC)
  • Blood chemistry studies to measure the amounts of certain substances released into the blood by organs and tissues in the body
  • Chest x-ray
  • Peripheral blood smear to check for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells
  • Bone marrow aspiration and biopsy, tumor biopsy or lymph node biopsy
  • Cytogenetic analysis to look for certain changes in the chromosomes
  • Immunophenotyping to diagnose the subtype of AML by comparing the cancer cells to normal cells of the immune system
  • Lumbar puncture (LP or spinal tap) to collect cerebrospinal fluid from the spinal column

Treatment of childhood AML

Treatment options for childhood AML depend on:

  • The age of the child at diagnosis
  • Number of white blood cells in the blood at diagnosis
  • Whether the AML was caused by previous anticancer treatment
  • The subtype of AML
  • Whether there are certain chromosomal changes in the leukemia cells
  • Whether the child has Down syndrome. Most children with AML and Down syndrome can be cured of their leukemia
  • How well the leukemia responds to initial treatment
  • Whether the AML is newly diagnosed or has recurred (come back) after being treated
  • The length of time since treatment ended, for AML that has recurred

Treatment of childhood AML is overseen by a pediatric oncologist who works with a team of other pediatric health professionals to treat the illness. The team may consist of: Hematologist, Medical oncologist, Pediatric surgeon, Radiation oncologist, Endocrinologist, Neurologist, Neuropathologist, Neuroradiologist, Pediatric nurse specialist, Social worker, Rehabilitation specialist, and Psychologist.

The treatment of childhood AML is done in two phases:

  • Induction therapy: This is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission.
  • Consolidation /intensification therapy: This is the second phase of treatment. It begins once the leukemia is in remission. The purpose of postremission therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse.

Treatment options used for childhood AML are:

  • Chemotherapy: Use of drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
  • Radiation therapy: Use of high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Can be external radiation therapy or internal radiation therapy. External radiation therapy may be used to treat childhood AML that has spread, or may spread, to the brain and spinal cord.
  • Chemotherapy with stem cell transplant: Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body`s blood cells.
  • Other drug therapy: Arsenic trioxide and all-trans retinoic acid (ATRA) are anticancer drugs that kill leukemia cells, stop the leukemia cells from dividing, or help the leukemia cells mature into white blood cells. These drugs are used in the treatment of a subtype of AML called acute promyelocytic leukemia (APL). A type of anticancer drug called a tyrosine kinase inhibitor blocks the enzyme, tyrosine kinase. Tyrosine kinase causes stem cells to develop into more white blood cells (granulocytes or blasts) than the body needs. Imatinib (Gleevec) is a type of tyrosine kinase inhibitor.
  • Supportive care: Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care may include the following:
    • Transfusion therapy: A way of giving red blood cells, white blood cells, or platelets to replace blood cells destroyed by disease or cancer treatment.
    • Drug therapy, such as antibiotics.
    • Leukapheresis: A procedure in which a special machine is used to remove white blood cells from the blood. Blood is taken from the patient and put through a blood cell separator where the white blood cells are removed. The rest of the blood is then returned to the patient`s bloodstream.

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