Childhood Acute Myeloid Leukaemia

Acute myeloid leukaemia (AML) is a blood cancer which affects the myeloid cells, which include red cells, platelets and some white blood cells. AML stops the body producing enough of these cells.

There are several different subtypes of AML, and the type your child has will depend on which type of myeloid cell is mainly being produced in excess. One important subtype is called acute promyelocytic leukaemia (APL) and it makes up about 1 in 10 cases of AML. Knowing whether or not your child has APL is important because it is treated very differently to other subtypes. Special tests will be done to distinguish between APL and other types of AML.

AML in childhood is rare, it only accounts for 15% of all leukaemias in children.

You can watch Jenson’s story above.

What causes Childhood AML?

In most cases, there is no obvious cause for childhood AML and both boys and girls have about the same likelihood of developing AML.  AML does not normally run in families

There are some genetic conditions, such as Down’s syndrome, which are known to lead to an increased chance of developing AML. This type of AML is treated differently to standard AML and your consultant will provide detailed information about this if this is the case for your child.

What are the symptoms of Childhood Information?

Symptoms include:

  • your child may feeling more tired or breathess than normal
  • they may pick up infections more easily which last longer and are persistent
  • unusual bruising and bleeding
  • bone pain
  • enlarged liver or spleen
  • swollen gums
  • some patients who have a very high white cell count may develop a condition called leukostasis, in which blood flow is slowed because of thickening of the blood

Because your child is more at risk of picking up an infection, contact your hospital team if they develop any of these symptoms:

  • a raised temperature (38⁰C or higher)
  • coughing
  • confusion or agitation
  • rapid heartbeat and fast breathing
  • shivering
  • quickly becoming ill
  • increased pain
  • excessive tiredness

Diagnosis of Childhood AML

Childhood AML is diagnosed by tests which may include:

  • blood tests
  • cytogenetics (Cytogenetics is the study of gene changes and investigates the genetic differences between AML cells and normal cells)
  • bone marrow samples.

Other tests may be done including lumbar puncture and x-rays.

Blood tests and bone marrow samples will be repeated throughout treatment to monitor response.

Risk grouping

The most important part of classifying childhood AML is risk grouping. There are three risk groups in AML; high, standard and low risk and your child will be classified into a risk group based on the results of the tests they had at diagnosis. Risk grouping is a way of estimating how likely it is that treatment will be successful.

Classification of AML

There are also two systems used to classify AML; the French-American-British (FAB), and the World Health Organisation (WHO) systems. The main difference is that the FAB system is mainly based on the appearance of the AML cells under the microscope, while the WHO system also uses information on the specific genetic changes in the AML cell (cytogenetics).

FAB classification

This is an older classification system, but is still widely used and is particularly useful for initial classification before cytogenetic results are available. It is based mainly on the appearance of the AML cells under the microscope, sometimes using special stains. It does not relate to the severity of AML; in other words, M7 is not more severe than M0 or vice-versa.

FAB sub-type Description
M0 AML minimally differentiated
M1 AML with minimal maturation
M2 AML with maturation
M3 Acute promyelocytic leukaemia
M4 Acute myelomonocytic leukaemia
M4 eos Acute myelomonocytic leukaemia with eosinophilia
M5 Acute monocytic leukaemia
M6 Acute erythroid leukaemia
M7 Acute megakaryoblastic leukaemia

WHO classification

The WHO classification uses the same elements as the FAB system, but places an emphasis on cytogenetic data, which is not used in the FAB system. There are five main categories in the WHO system:

  • AML with recurrent genetic abnormalities
    • The abnormal cells have certain specific genetic changes
  • AML with myelodysplasia-related changes
  • AML in patients previously diagnosed with MDS or with features similar to MDS
  • AML in patients who have previously had chemotherapy and/or radiation therapy
  • This only occurs in children
  • does not fall into above categories
  • Therapy-related myeloid neoplasms
  • Myeloid proliferations related to Down’s syndrome
  • AML not otherwise categorised

What happens next?

Because AML progresses rapidly, virtually all children with AML start treatment soon after diagnosis. You can refuse treatment for your child at any time, but it is important that you understand clearly what might happen in this case. If your child’s haematologist does not think your child needs treatment, you cannot insist on starting treatment, but this is rare with AML. You can ask for a second opinion at any time. As far as possible, all decisions about your child’s treatment will take your wishes into account.

Treating Childhood AML

Virtually all patients will start treatment immediately. Childhood AML has better outcomes and is often curable with standard treatments compared to AML in adults. It is important to discuss the outlook (prognosis) with your child’s medical team, because it is affected by various factors such as the risk group.

The main reason a child may not start treatment would be if their general medical condition makes treatment too risky. This is very rare and if it affects your child you will be given full information by their specialist.

The main ways in which Childhood AML is treated are:

  • Chemotherapy – cell killing drugs
  • Stem Cell Transplant
  • Supportive Care

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.  Conventional chemotherapy should take about five or six months and involves four courses of treatment each lasting four to six weeks.

For children, chemotherapy is given as intensive treatment, which means higher doses and/or treatment over a longer period of time.

AML cells may be found in the fluid around the brain and spine (called CSF). If this is the case, children will normally have chemotherapy drugs injected into the CSF (intrathecal injection), this is part of the first two courses of treatment.  Usually, this is enough to kill any leukaemia cells in the CSF, if any are found after two courses of intrathecal injections, your child may receive radiotherapy to prevent a relapse.

Stem cell transplant

If your child has high risk AML, a stem cell transplant may be recommended. Usually children only have a stem cell transplant if their AML returns after remission (relapse).

A stem cell transplant involves the use of high-dose chemotherapy to kill as many as possible of the leukaemia cells. This also destroys the bone marrow’s ability to make new blood cells, so the child is given healthy stem cells.

Children tend to do better than adults when they are given a stem cell transplant. If this is an option for your child, then their haematologist will discuss it with you and give you the chance to ask questions.

Supportive care

Supportive care is directed at controlling the symptoms and side effects caused by the disease, rather than treating the disease.

This can include:

  • antibiotics to treat bacterial infections
  • antifungals to treat fungal infections
  • eye drops
  • blood and platelet transfusions
  • heart scans to check that the chemotherapy is not affecting the heart in any way

The side effects of treatment vary between different types of treatment and different patients.

You will be given detailed information about any likely side effects before your child’s treatment starts.

Further downloads

We have free patient information available for Childhood AML patients.

You can download the booklets on our information pages here.

Alternatively, you can have the information delivered free of charge by requesting it through our resources page. 

Patient stories

Published date: March 2016

Review date: March 2018