Acute myelogenous leukemia

How is AML diagnosed?

There are many diagnostic procedures that may be used to determine whether your child has AML. In addition to a complete medical history and physical examination, some of these may include:

• bone marrow aspiration and biopsy- Marrow may be removed by aspiration or a needle biopsy under local anesthesia. In aspiration biopsy, a fluid specimen is removed from the bone marrow. During a needle biopsy, marrow cells are removed. These methods are often used together. Most often samples are obtained from the bones of your child’s pelvis.
• complete blood count (CBC) - a measurement of size, number and maturity of different blood cells in a specific volume of your child’s blood
• additional blood tests - may include blood chemistries, evaluation of liver and kidney functions and genetic studies
• chromosomal analysis - additional tests that can help distinguish AML from ALL or other leukemias and help your child’s physicians tailor treatment to the specific disease
• spinal tap/lumbar puncture - A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in your child’s spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (called CSF—the fluid that bathes your child’s brain and spinal cord) can be removed tested.

What is the treatment for AML?

At Children’s, we know how difficult a diagnosis of AML can be, both for your child and for your whole family. That’s why our physicians are focused on family-centered care: From your first visit, you’ll work with a team of professionals who are committed to supporting all of your family’s physical and psychosocial needs.

Treatment usually begins by addressing your child’s symptoms, such as anemia, bleeding, and/or infection. In addition, treatment may include (alone or in combination) the following:

Chemotherapy

Chemotherapy is a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce.

How is chemotherapy given?

Different chemotherapies may be given:

• as a pill to swallow
• as an injection into the muscle or fat tissue
• intravenously (directly to the bloodstream, also called IV)
• intrathecally (directly into the spinal column with a needle)

How is chemotherapy used?

This depends on many factors. Several things to keep in mind:

• A number of combinations of chemotherapy drugs are currently being used to stabilize and, in some cases, shrink the size of the tumor.
• Depending on the type of cancer, chemotherapy drugs may be given in a specific order.
• Chemotherapy may be used alone for some types of cancer, or in conjunction with other therapy such as radiation or surgery.

Does chemotherapy come with bad side effects?

While chemotherapy can be quite effective, the drugs do not differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help your child, family and your child’s health care team prepare for and sometimes prevent these symptoms from occurring.

Intrathecal medications/chemotherapy

These are medications inserted through a needle into your child’s spinal cord into the area called the subarachnoid space.

Radiation therapy

Radiation therapy uses high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.

Stem cell transplant

Stem cells are a specific type of cell from which all blood cells develop. They can develop into red blood cells to carry oxygen, white blood cells to fight disease and infection, and platelets to aid in blood clotting. Stem cells are found primarily in the bone marrow, but some also circulate in the blood stream.

When your child’s stem cells are replaced with those of a healthy and compatible donor, it is called allogeneic transplantation:

1. Treatment may begin with high-dose chemotherapy (perhaps combined with radiation therapy) to destroy all of the bone marrow, stem cells and cancerous cells, in your child’s body.
2. Then, healthy stem cells from another person (whose tissue must be the same, or almost the same as your child’s) are used to help restore your child’s normal blood production.

Biological therapy

Biological therapy refers to a wide range of substances that may be able to involve the body's own immune system to fight cancer or lessen harmful side effects of some treatments.

Other medications

Other medications may be given to prevent or treat damage to other systems of your child’s body caused by leukemia treatment or for nausea and side effects of treatment.

Blood transfusions

A blood transfusion could replace or supplement your child’s red blood cells and platelets.

Antibiotics

Your child may be given antibiotics may be given to prevent or treat infections.

Continuous follow-up care

Your child’s health will be closely monitored to determine response to treatment, detect recurrent disease and manage late effects of treatment.

What are the various stages of leukemia treatment?

Stages in the treatment of leukemia include:

• Induction - Induction is the first stage of treatment. It is a combination of chemotherapy and medications given to stop abnormal cells from being made in the bone marrow.
  • The goal of this stage is remission. This means leukemia cells are no longer visible under the microscope when examining either the bone marrow or blood.
  • The induction phase may last approximately one month and can be repeated if remission is not achieved.
  • However, even when remission is achieved, leukemia is still present in the body, which is why further therapy is necessary
• Intensification or consolidation
  • Intensification or consolidation is continued treatment with chemotherapy to kill leukemia cells.
  • This phase may include chemotherapy given to the central nervous system to kill any leukemia cells present there, or to prevent the spread of leukemia cells to the spinal cord or brain.
  • Radiation therapy may also be given to the brain during this phase.

What is the long-term outlook for my child with leukemia?

Your child’s prognosis greatly depends on:

• the extent of the disease
• the cancer’s response to treatment
• genetic abnormalities of the leukemia
• his age and overall health
• his tolerance of specific medications, procedures or therapies
• new developments in treatment

Relapse can occur during any stage of treatment, even with aggressive therapy, or may occur months or years after treatment has ended.

As with any cancer, prognosis and long-term survival can vary greatly. Prompt medical attention and aggressive therapy are important for the best prognosis, and continuous follow-up care is essential. New methods are continually being discovered to improve treatment and decrease side effects of the treatment for the disease.