All children with AML are initially treated with chemotherapy. The course of chemotherapy is usually 4-5 months. Some patients may receive a bone marrow transplant following initial chemotherapy.
Chemotherapy
Chemotherapy is the primary treatment for AML. Drugs that are able to kill cancer cells are known as chemotherapy. The drugs selected for treatment are based on the specific cancer diagnosis. Chemotherapy for AML may be given by mouth, injected into a vein, or injected into the central nervous system with a spinal tap (intrathecal). Almost all types of AML are treated with same way. There is one type that is treated differently due to its unique features.
Chemotherapy for AML is usually divided into phases of treatment, called induction, consolidation and intensification.
Induction: the first part of treatment. The goal of this phase is to kill the leukemia cells and allow normal blood cells to return. The chemotherapy usually reduces the white blood cells to zero, and it takes several weeks for healthy bone marrow to regrow. Infection is a major risk during this period, and patients remain in the hospital until there is evidence of a regrowth of healthy white blood cells. A bone marrow aspirate is performed at the end of this phase. The bone marrow is looked at under a microscope, and is expected to show only normal cells. This is called remission. This does not mean that the child is cured, because without further treatment the disease will return. This phase of treatment usually lasts about 4 weeks, but may be longer depending upon the length of recovery of normal blood cells.
Consolidation: the second part of treatment to kill any leukemia cells remaining in the body. This phase usually lasts about 4-6 weeks. Again, infection is a major risk and patients may need to be hospitalized until there are enough healthy white blood cells to fight infection.
Intensification: Additional chemotherapy to kill remaining leukemia cells. This phase usually lasts about 8 weeks.
Blood and Bone marrow transplant (BMT)
If there is a family member (brother, sister, parent) who is a tissue type match, a bone marrow transplant usually will be recommended in first remission unless there are other favorable factors. The chances of staying in remission after a BMT is higher than with chemotherapy alone. Siblings of a patient (and sometimes parents) have blood tested to see if they are a tissue type match. This procedure is discussed here.
If a patient has not achieved remission with the initial chemotherapy, a blood or marrow transplant from an unrelated donor may be recommended. The risks of unrelated donor blood or marrow transplant are higher than with a matched family member, so this procedure is considered in first remission only for patients at very high risk for relapse.
Bone marrow tests and spinal taps will be done periodically during treatment to allow the doctors to see that the leukemia is in remission and staying in remission. Once therapy is discontinued, periodic blood counts will be performed to see if the leukemia is staying in remission.
What are the general effects of chemotherapy?
Chemotherapy attacks rapidly dividing cells, including those in normal tissues such as the hair, lining of the mouth, intestines, and bone marrow. This is why children on chemotherapy can lose their hair, develop mouth sores, or have nausea, vomiting, and diarrhea. Other medicines are used to help ease some of these symptoms, such as nausea and vomiting, and mouth sores. In addition, chemotherapy drugs may lower blood counts. A decrease in white blood cells increases the risk infections, and almost all patients with AML require intravenous antibiotics when they have a fever. A decrease in platelets can lead to increased bruising and bleeding, and patients often require platelet transfusions. A decrease in red blood cells may cause fatigue, and patients often need transfusions of red blood cells. Once chemotherapy is completed, symptoms go away, and blood counts return to normal. .
Are all patients with AML treated the same way?
With the following exceptions, patients all receive the same treatment.
- Down Syndrome: children with Down syndrome generally require less intensive chemotherapy to achieve a cure and are treated with less intensive chemotherapy.
- Leukemia subtype M3 (acute promyelocytic) : receive different chemotherapy with special agents that are different from drugs used for other subtypes. These patients respond well to this unique therapy and generally do not receive a bone marrow transplant in first remission.
- Specific chromosomal changes in the leukemia cell including:
- Monosomy 7 (loss of all or part of chromosome 7): does not respond well to chemotherapy and patients often receive a blood or marrow transplant in first remission.
- Inversion 16: responds well to chemotherapy and patients may not be recommended for bone marrow transplant in first remission.
- Central nervous system disease at diagnosis (blasts in the cerebrospinal fluid). Some children may have blast cells in the fluid collected at the first spinal tap. They receive extra chemotherapy given with spinal taps to kill these cells.
What is the cure rate for children with AML?
In most children, the signs and symptoms of the disease are absent after induction, and most children will be in remission after induction. Approximately 50% of children will be cured of AML with chemotherapy and if available, a bone marrow transplant using a matched related donor.
What if the leukemia returns?
If leukemia returns (relapses) it usually happens within the first two years from diagnosis. Additional chemotherapy may be given to get the child back into remission. At that point, a BMT will be considered to maintain remission. If a related donor is not available, then an unrelated donor may be considered.
For more information on the treatment of acute myeloid leukemia, see the section on: In Treatment, Medical Information.
Nancy Bunin, MD, Children's Hospital of Philadelphia
Reviewed and Edited
CureSearch Medical Editorial Board
April 2007