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This page is about acute myeloid leukaemia (AML)| in children. You may find it helpful to read it alongside the Macmillan/CCLG booklet A parent’s guide to children’s cancer|, which talks about children's cancers, diagnosis, treatment and support services.
One-third of all childhood cancers are leukaemia|, with approximately 400 new cases occurring each year in the UK. Less than a quarter of these are acute myeloid leukaemia (AML). AML can affect children of any age, and girls and boys are equally affected.
Leukaemia is a cancer of the white blood cells. All blood cells are produced in the bone marrow|, the spongy substance at the core of some of the bones in the body. Bone marrow contains:
There are two different types of white blood cell: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally white blood cells repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide, but do not mature.
These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are immature, they cannot work properly. This leads to an increased risk of infection. Because the bone marrow cannot make enough healthy red blood cells and platelets, symptoms such as anaemia and bruising can occur.
There are four main types of leukaemia: acute lymphoblastic (ALL)|, acute myeloid (AML), chronic lymphocytic (CLL)| and chronic myeloid (CLL)|. Chronic leukaemias occur mostly in adults, and are extremely rare in children and young people. Each type of leukaemia has its own characteristics and treatment.
This information is about acute myeloid leukemia. If your child's cancer is one of the other types listed above, our cancer support specialists| can give you further information about it.
Acute myeloid leukaemia is an overproduction of immature myeloid white blood cells (blast cells).
Cells that have started to show some of the features of myeloid cells are said to show differentiation. Cells which do not show signs of becoming a particular type of white blood cell are known as undifferentiated.
There are different sub-types of AML, depending upon exactly which type of cell has become leukaemic, the stage of development (maturation) the cells are at and whether the cells are differentiated. Knowing the sub-type of AML is important, as it helps doctors decide on the best treatment.
There are several classification systems for the sub-types of AML. The most commonly used system in the UK is the French-American-British (FAB) system.
M0 – AML with minimal evidence of myeloid differentiation
M1 – AML without maturation
M2 – AML with maturation
M3 – Acute promyelocytic leukaemia (APL)
M4 – Acute myelomonocytic leukaemia
M5 – Acute monocytic/monoblastic leukaemia
M6 – Acute erythroleukaemia
M7 – Acute megakaryoblastic leukaemia
A newer system known as the WHO (World Health Organisation) classification system is also sometimes used.
The exact cause of AML is unknown. Research into possible causes of this disease is ongoing. Children with certain genetic disorders, such as Down’s syndrome or Li-Fraumeni syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with AML have a slightly increased risk of developing AML, although this risk is still small. Other non-cancerous conditions, such as aplastic anaemia or the myelodysplastic syndromes|, may increase a child’s risk of developing it.
In recent years, there has been publicity about leukaemia occurring more often in children who live near nuclear power plants or high-voltage power lines. Research is being carried out to see if there is any definite link between these factors and leukaemia, but at present there is no evidence of this.
AML, like other types of cancer, is not infectious and cannot be passed on to other people.
As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired| and lethargic because of anaemia, which is caused by a lack of red blood cells.
Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood. Sometimes they may suffer from infections| because of low numbers of normal white blood cells.
A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands.
At first, the symptoms| are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear.
A blood test usually shows low numbers of normal white blood cells and the abnormal leukaemia cells. A sample of bone marrow is needed to confirm the diagnosis. The bone marrow sample is also examined to check for any abnormalities in the chromosomes of the leukaemia cells.
A test called a lumbar puncture| is done to see if the spinal fluid contains any leukaemia cells. A chest x-ray is also done, which will show if there are any enlarged glands in the chest. Other tests| may be necessary, depending on your child’s symptoms.
These tests will help to identify the precise type of leukaemia. The booklet A parent’s guide to children’s cancer has more information.
The aim of treatment for AML is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy| is the main treatment for AML. Usually a combination of chemotherapy drugs is given. The treatment usually has different phases:
This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible. It usually involves two courses (cycles) of a combination of chemotherapy drugs|. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. When there is no evidence of leukaemia, the child's condition is referred to as being in remission.
When there are no signs of the leukaemia in the blood or bone marrow, further treatment is often given. This phase of the treatment aims to destroy any leukaemia cells that may be left and to help stop the AML from coming back. This treatment usually involves two or three more courses of chemotherapy.
This treatment| is usually only used for children with AML that is likely to come back following standard chemotherapy or for children whose leukaemia has come back (recurred) following standard treatment.
AML may sometimes develop in the brain and spinal cord. This can be prevented by injecting chemotherapy drugs directly into the spinal fluid during a lumbar puncture (intrathecal chemotherapy|). Intrathecal chemotherapy is usually given after each of the first two courses of chemotherapy. Sometimes a more intensive treatment is needed, and the intrathecal drugs are given more frequently until all the regular chemotherapy has been completed. Occasionally, radiotherapy| to the brain is also necessary.
Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects are:
Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your child’s doctor or nurse will talk to you about any side effects.
A small number of children may develop late side effects|, sometimes many years later. These include possible problems with puberty and fertility, a change in the way their heart works, and a small increase in their risk of developing a second cancer in later life. Your child’s doctor or nurse will talk to you about any possible late side effects.
More detailed information about these late side effects is available in the Macmillan/CCLG booklet A parent’s guide to children’s cancer.
Many children have their treatment as part of a clinical research trial|. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for AML. If appropriate, your child's medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is often provided to help explain things.
Taking part in a research trial is completely voluntary, and you'll be given plenty of time to decide if it's right for your child.
Many children with AML are cured. If the leukaemia comes back| after initial treatment, it usually does so within the first three years. Most children with AML grow and develop normally.
If you have specific concerns about your child’s condition and treatment, it is best to discuss them with your child’s doctor, who knows the situation in detail.
As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many different emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions| and are part of the process that many parents go through at such a difficult time.
It's not possible to address here all of the feelings you may have. However, the booklet A parent’s guide to children’s cancer talks about the emotional impact of caring for a child with cancer, and suggests sources of help and support.
Your child may have a variety of powerful emotions| throughout their experience of cancer. The parent's guide discusses this further and talks about how you can support your child|.
Our booklet Peppermint Ward |is a storybook for younger children with cancer. It looks at the issues that they and their family may face and helps them explore their feelings.
This section has been compiled using information from a number of reliable sources, including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.