Acute myelogenous leukemia

What is leukemia?

Leukemia is blood cancer. It develops in the bone marrow—the soft, spongy center of the long bones that produces the three major blood cells:

• white blood cells (fight infection)
• red blood cells (carry oxygen)
• platelets (help blood clot and stop bleeding)

Normal, healthy cells only reproduce when there is enough space for them to fit, and the body regulates this by sending signals so the cells know when to stop. When your child has leukemia, two things happen:

1. His bone marrow makes white blood cells that are abnormal.
2. These abnormal cells do not respond to the signals to stop, and keep reproducing regardless of space available.
3. The abnormal/immature white cells, called “blasts,” reproduce quickly, and—unlike normal white blood cells—do not help fight infection.
4. When blasts begin to crowd out the healthy cells in the bone marrow, your child begins to experience symptoms of leukemia (e.g., infections, anemia, bleeding).

What is acute myelogenous leukemia (AML)?

In the form of the disease known as acute myelogenous leukemia (AML), the white blood cells that are affected are a specific kind called myeloid cells, or “myeloblasts.”

• AML may be also called granulocytic, myelocytic, myeloblastic, or myeloid leukemia.
• It accounts for about 20 percent of the childhood leukemias.
• With AML, these cells are most commonly found in the bone marrow and blood, but can also appear in the spinal fluid and the skin.
• Rarely, they can form into solid tumors called chloromas.
• The symptoms associated with AML usually occur over a short period of days to weeks.

As you read further below, you will find general information about AML. If you would like to view summary information about cancer first, see the cancer overview.

What causes AML?

In nearly all cases, it’s not known what causes leukemia. In the majority of childhood leukemias, gene mutations and chromosome abnormalities in the leukemia cells occur sporadically (by chance). The abnormalities found in leukemia cells are not found in the other cells of the body.

Are there any risk factors associated with AML?

If your child has certain genetic syndromes, including Fanconi anemia, Bloom syndrome, Kostmann syndrome, and Down syndrome, he may be at a higher risk of developing AML than other children.

Can damage to the child’s immune system lead to leukemia?

Your child’s immune system plays an important role in protecting his body from diseases, and possibly cancer. This means that an alteration or defect in his immune system may increase the risk for developing leukemia.

Factors such as exposure to certain viruses, environmental factors, chemical exposures and various infections have been associated with damage to the immune system, but none of these factors has been definitively linked as a cause of childhood leukemia.

What are the different types of leukemia?

In addition to acute myelogenous leukemia (AML), there are two other main types of leukemia, acute lymphoblastic leukemia (ALL) and chronic myelogenous leukemia (CML).

How do myelogenous leukemias differ from lymphoblastic leukemia?

A different type of white blood cell is affected. In myelogenous leukemias (both AML and CML) it’s the granulocyte; in lymphoblastic leukemia (ALL), it’s another kind called alymphocyte. In all cases—AML, CML and ALL—the cells become abnormal, reproduce too quickly, ignore orders to stop and crowd out healthy blood cells.

What’s the difference between AML and CML?

Chronic myelogenous leukemia (CML):

• is uncommon in children
• can occur over a period of months or years instead of coming on more quickly, as AML tends to do.

CML is also often accompanied by a specific type of chromosome rearrangement:

1. Part of chromosome #9 breaks off and attaches itself to chromosome #22.
2. There is an exchange of genetic material between these two chromosomes.
3. This rearrangement changes the position and functions of certain genes, which results in uncontrolled cell growth.

If your child has CML, he may have other chromosome abnormalities.

What determines what kind of leukemia my child’s body produced? =

The type of leukemia (lymphoblastic or myelogenous) is determined by the stage of development of the cells when they become leukemia cells.

1. All blood cells—white blood cells, red blood cells and platelets—start life as pluripotent stem cells. This stem cell goes through stages of development until it matures into a functioning cell.
2. Early in its development, the stem cell becomes either
   • a lymphocyte precursor cell
   • a myeloid precursor cell

In turn, each of those precursor cells may mature to become benign or malignant (leukemia cells).

What are the symptoms of AML?

Because leukemia is cancer of the blood-forming bone marrow, the initial symptoms are often related to abnormal bone marrow function. The bone marrow is responsible for storing and producing about 95 percent of the body’s blood cells, including the red blood cells, white blood cells, and platelets.

While each child may experience symptoms differently, some of the most common include:

• anemia– When your child’s bone marrow is too crowded for red blood cells to be produced, anemia is present. Your child may appear tired, pale and may breathe faster to compensate for the decrease in his cells’ ability to carry oxygen. A blood count will show fewer than normal red blood cells.
• bleeding and/or bruising– When your child’s marrow is too crowded to allow platelets to be produced, bleeding can occur and your child may begin to bruise more easily. You might notice petechia—tiny red dots often seen on the skin when a child has a low number of platelets. These are very small blood vessels that have "leaked" or bled. A blood count will show thrombocytopenia, a decreased number of platelets.
• recurrent infections- Although there may be an unusually high number of white blood cells on your child’s blood count, these white blood cells are immature and do not fight infection. Your child may have had several viral or bacterial infections over the past few weeks, and may show symptoms of an infection such as fever, runny nose and cough.
• bone and joint pain– Your child may also experience pain in his bones and joints. This pain is usually a result of the bone marrow being overcrowded and "full."
• abdominal pain– stomach aches may also be a symptom of leukemia. Leukemia cells can collect in your child’s kidney, liver and spleen, causing enlargement of these organs. Pain in the abdomen may cause your child lose his appetite and lose weight.

With AML, these symptoms usually occur over a number of days or weeks.

It’s important to understand that the symptoms of leukemia may resemble other blood disorders or medical problems. These are common symptoms of the disease, but do not include all possible symptoms. Always consult your child's physician for a diagnosis.