About Acute Myelogenous Leukemia (AML) in Children
The pathophysiologic causes of AML in children are primarily genetic mutations. These mutations lead to the uncontrolled growth of immature myeloid cells in the bone marrow. The exact reasons why mutations occur is unknown. However, there are some risk factors associated with pediatric AML.
Non-modifiable risk factors for AML (factors that a person cannot change or control) include:
- Having a sibling with leukemia
- Past treatment with chemotherapy or radiation therapy
- Being exposed to ionizing radiation (such as X-rays)
- Being exposed to certain chemicals, such as benzene
- Having certain inherited disorders or syndromes, such as Down syndrome, Fanconi anemia, Neuorfibromatosis type 1, Li-Fraumeni syndrome, or Noonan syndrome.
Modifiable risk factors for AML in children (factors a person can potentially change or control) haven’t been definitively identified. Environmental exposures for childhood AML are still being researched to fully understand these aspects.
Common symptoms of AML in children include:
- Fever
- Drenching night sweats
- Fatigue (weakness, feeling very tired)
- Shortness of breath
- Easy bruising or bleeding
- Petechiae (pinpoint spots on the skin caused by bleeding underneath the skin)
- Pale skin
Additional symptoms that may occur as AML progresses may include:
- Frequent infections
- Abnormal bleeding, such as frequent nosebleeds and gum bleeding
- Bone or joint pain
- Swollen lymph nodes, noticeable as painless lumps in the neck, underarm, stomach or groin)
- Loss of appetite and weight loss
- Headaches
It's important to note that these symptoms are not specific to AML and can be caused by other conditions as well. If you notice any of these symptoms in your child, it's important to consult a healthcare professional for a proper diagnosis. They will be able to evaluate your child's symptoms, perform necessary tests, and provide appropriate treatment if needed.
To diagnose AML in children, the following examinations, tests, and procedures are commonly performed:
- Physical exam and health history: This includes checking for signs of disease and gathering information about the child's symptoms, health habits and past illnesses.
- Complete blood count (CBC) with differential: A blood sample is drawn to check the number and type of white blood cells, red blood cells, platelets, and the amount of hemoglobin in the red blood cells.
- Bone marrow aspiration and biopsy: A small amount of bone marrow and a small piece of bone are removed to examine the cells under a microscope.
Additional examinations, tests or procedures may be performed to determine the type of AML and severity (spread to other parts of the body outside of the bone marrow. These may include:
- Imaging studies: Chest X-rays and other imaging techniques can help determine if leukemia cells have spread to other parts of the body.
- Lumbar puncture (spinal tap): A sample of cerebrospinal fluid is taken to check if leukemia cells have spread to the brain or spinal cord.
- Genetic testing: This helps identify specific genetic changes in leukemia cells that may affect treatment options.
- Flow cytometry: This test analyzes the characteristics of leukemia cells to help classify them and guide treatment decisions.
- Cytogenetic analysis: This examines the chromosomes in leukemia cells to identify any abnormalities that may impact prognosis and treatment options.
Remember, these are general descriptions and specific tests may vary depending on individual cases. It's important to consult with a healthcare professional for personalized advice.
The goals of treatment for AML in children are to achieve remission, prevent relapse, and improve overall survival rates.
Treatment of AML in children often has two phases:
- Induction: Thie goal of this first phase of treatment is to kill leukemia cells in the blood and bone marrow to put AML into remission. Remission means that signs and symptoms of the leukemia have been reduced or are no longer seen.
- Consolidation or Intensification: The goal of this second phase of treatment is to kill remaining leukemia cells that may be inactive and hiding outside of the blood and bone marrow. These inactive leukemia cells could begin to grow and cause a relapse (return of the leukemia).
The following are treatment options that may be used within these phases. A combination of treatments is often used.
- Chemotherapy: Combination chemotherapy is the mainstay of AML treatment in children. It involves using multiple drugs to target and kill cancer cells. Chemotherapy drugs work by interfering with the growth and division of cancer cells. Chemotherapy may be given in cycles.
- Radiation therapy: This therapy uses high-energy X-rays or other radiation to kills cancer cells or keep them from growing. Radiation therapy is not always used. It may be used for pediatric AML that doesn’t respond to chemotherapy.
- Central nervous system prophylaxis: Leukemia cells may enter the central nervous system (brain and spinal cord). Therapy with intrathecal chemotherapy (chemotherapy administered into the spinal fluid) may be used to prevent cancer cells from spreading to the central nervous system.
- Targeted therapy: This type of treatment uses medications or other substances to identify and attack specific cancer cells. They are often used as adjuncts (given after) other treatments like chemotherapy. Examples of targeted therapies are:
- Tyrosine kinase inhibitors: The inhibitors block an enzyme needed for stem cells to become white blood cells. This helps keep the bone marrow from producing too many immature white blood cells.
- Monoclonal antibodies: These antibodies attach to cancer cells to help block their growth. Some monoclonal antibody treatments can also kill cancer cells.
- Stem cell transplant: This procedure may be considered for some children with AML. It involves replacing damaged bone marrow with healthy stem cells, which can develop into healthy blood cells.
- Supportive therapies: Other medications or therapies may be used as part of the treatment plan to help manage complications of AML or its treatment. These may include:
- Tranfusions of red blood cells or platelets
- Antibiotics or antifungals to prevent or treat bacterial or fungal infections
- Antinausea medications to help prevent or treat nausea. These may also be called antiemetics.
There may be clinical trials to test new therapies to treat AML in children. It is important to discuss clinical trials with the healthcare team to determine if a clinical trial is an option based upon your child’s specific situation.
These treatments work together to eradicate cancer cells, restore normal blood cell production, and improve long-term outcomes for children with AML. Remember, individual treatment plans may vary, so it's essential to consult with healthcare professionals for personalized advice.