Acute Myeloid Leukemia (AML) in Children
Leukemia is a type of cancer that affects the patient’s blood, more specifically the white blood cells, and it first starts in the bone marrow. We can classify leukemias based on what type of white blood cells they affect and how quickly they spread. Leukemia can be lymphoid or myeloid and acute or chronic.
Acute myeloid leukemia or AML for short, is a type of leukemia that leads to an abnormal number of blood cells being produced. It’s usually found in adults but it can affect children as well. Out of all diagnosed AML cases, approximately 17% are childhood cases.
If a child is healthy, their bone marrow produces immature cells known as stem cells that mature over time. However, due to a genetic mutation, these cells can become either myeloid or lymphoid stem cells, and this is how leukemia starts.
AML develops when a bone marrow cell mutates and its genetic material is changed, affecting myeloid cells, which are a group of white blood cells. Childhood AML can affect children of all ages, but it’s usually seen in children younger than two and teenagers.
AML in Children Signs And Symptoms
These are some of the most common symptoms of childhood AML:
A drop in red blood cell count (anemia) may cause the following signs and symptoms:
- A high fever that can appear by itself or following an infection.
- A skin rash.
- Blue or purple lumps that appear in the neck, stomach, underarm or groin. These lumps are painless.
- Skin that easily bruises or bleeds.
- An unexplained loss of appetite and sudden weight loss.
- Pain in the bones and/or joints, typically below the ribs.
- Shortness of breath, weakness and fatigue.
- Painless lumps that appear around the eyes. They are usually a blue-green color.
- Persistent headaches or migraines.
AML in Children Causes And Risk Factors
- Aplastic anemia
- Ataxia telangiectasia.
- Diamond-Blackfan anemia.
- Down syndrome.
- Dyskeratosis congenita.
- Fanconi anemia.
- Kostmann syndrome.
- Li-Fraumeni syndrome.
- Myelodysplasia syndrome (MDS)
- Neurofibromatosis type-1.
- Noonan syndrome.
- Shwachman-Diamond syndrome
AML in Children Diagnosis
If your child is displaying any AML symptoms or has some risk factors that could increase their chances of developing the disease, a doctor can give them a proper diagnosis.
Diagnosing acute myeloid leukemia requires multiple different tests.
Complete Blood Count (CBC) with Peripheral Blood Smear
As acute myeloid leukemia is a type of cancer that affects the blood, or more specifically blood cells, one of the first steps in getting a diagnosis is always to perform a blood test.
If a doctor suspects the presence of AML or any other type of leukemia, they will do a CBC alongside a peripheral blood smear. These tests will show the total amount of red blood cells, white blood cells, and platelets in the patient’s body, and what the cells look like under a microscope.
Bone Marrow Aspiration and Biopsy
If the blood tests show any irregularities, the next step will be to perform a bone marrow aspiration and biopsy. This is a procedure during which a medical professional extracts part of the bone marrow and peace of the bone from the patient’s hipbone or breastbone with a small hollow needle.
Afterward, they will examine that sample under a microscope and look for any abnormalities and signs of cancer.
AML can sometimes spread, and the most common area it spreads to is the central nervous system, which is the brain and spinal cord. If the doctor determines the presence of AML with a bone marrow aspiration and biopsy, they will perform a lumbar puncture to see whether it’s spread.
Finding the presence of AML is only the first step of the diagnosis process. For the child to receive adequate treatment, the medical professional in charge of their case will need to get a more accurate picture of the specific condition.
To do this, they will perform a couple of different laboratory tests:
- Cytochemistry. During this test, the patient’s cells are exposed to a certain type of dye that only reacts when it comes into contact with leukemia cells. If the color of the dye changes, the doctor will be able to determine if the cells are cancerous.
- Flow cytometry and immunohistochemistry. These two techniques are often grouped together, as their main purpose is to examine a cell population. During these tests, samples of a cell are treated with antibodies and the results can determine what type of leukemia the patient has.
- Fluorescent in situ hybridization (FISH). AML patients often exhibit certain chromosomal changes which are often crucial for the diagnosis process. These changes often can’t be seen with other tests, which is why doctors use FISH.
AML in children treatment
When AML gets diagnosed, the most crucial thing is to get treatment as soon as possible. There are multiple different treatment options for acute myeloid leukemia, and the doctor will decide which is the best option for each individual case.
Most AML cases are treated with chemotherapy as the first line of defense. Chemotherapy treatment for leukemia as well as other types of cancer is typically divided into three phases:
Phase 1 – Induction. Induction chemotherapy lasts for a short time, typically only a week, and during this phase of treatment the patient is given intense chemotherapy drugs. This is done to try to significantly reduce the number of cancerous cells in the patient’s body.
Phase 2 – Consolidation. During this phase of chemotherapy, the patient gets chemotherapy in cycles as well as rest periods in between. The goal of consolidation is to get rid of any cancerous cells that are left over in the body after the induction phase.
Phase 3 – Maintenance. This phase isn’t required for all AML patients, only those who have a more severe form of the disease. It includes treating the patient with chemotherapy for multiple months or even years.
Unlike chemotherapy, which kills both the cancerous cells and the healthy cells around it, targeted therapy only finds and, as the name suggests, targets leukemia cells. The drugs used for targeted therapy attack the proteins and genes leukemia cells need to survive, divide and grow.
Radiation therapy is a type of cancer treatment that kills cancerous cells by using high doses of radiation. In most cases, doctors wouldn’t use radiation therapy to treat AML unless it has already spread to other parts of the body.
Another example of where this type of treatment could be used is if a patient needs to receive a bone marrow transplant, radiotherapy will be given before the transplant.
Bone Marrow Transplant
A bone marrow transplant is a procedure that is sometimes needed after high doses of chemotherapy. Since chemotherapy is a very aggressive type of treatment, it often damages the bone marrow, which is responsible for producing white and red blood cells as well as platelets.
If the bone marrow gets damaged, the doctors will perform a bone marrow transplant to ensure the patient’s body will be able to produce healthy blood cells.
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