Definition

Leukemia is a type of cancer that develops in the bone marrow. With acute myeloid leukemia (AML), the bone marrow makes abnormal myeloid cells that are precursors to blood cells, including:

• Myeloblasts (a type of white blood cell) that fight infection
• Red blood cells that carry oxygen
• Platelets that make blood clots and stop bleeding in cuts and bruises

The leukemia cells do not function normally. They cannot do what normal blood cells do, like fight infections. The abnormal cells also overgrow the bone marrow, forcing normal cells out. Without normal cells, anemia and bleeding problems develop. They also cannot fight infections properly.

Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

It is not clear exactly what causes these problems in the cells, but it is probably a combination of genetics and environment.

Risk Factors

AML is more common in those of Hispanic descent. Other factors that may increase your child’s risk of AML include:

• Genetic factors:
  • Having a sibling, especially an identical twin, who develops leukemia
  • Having a genetic condition, such as Down syndrome
• Exposure to radiation
• Exposure to certain chemicals, such as benzene, a chemical used in the cleaning and manufacturing industries
• History of other blood disorders, such as polycythemia vera, essential thrombocytosis, or myelodysplastic syndrome

Symptoms

AML may cause:

• Fever
• Frequent infections
• Shortness of breath
• Paleness (a sign of anemia)
• Easy bruising or bleeding
• Petechiae (flat, pinpoint spots under the skin caused by bleeding)
• Weakness, fatigue
• Loss of appetite, weight loss
• Bone and joint pain
• Painless lumps in the neck, underarms, stomach, or groin
• Bleeding gums

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. The doctor will check for swelling of the liver, spleen, and lymph nodes.

Test to assess bodily tissues or other structures include:

• Blood tests
• Bone marrow biopsy or aspiration
• Lumbar puncture
• Cytogenetic analysis
• Immunophenotyping

Imaging tests evaluate bodily structures. These may include:

• Ultrasound
• Chest x-ray
• CT scan
• MRI scan
• Gallium scan and bone scan

Once AML is identified, it can be classified. These subtypes are based on the type of cell from which leukemia developed. This is important because it can help the doctor make a prognosis and develop a treatment plan.

Treatment

Talk with the doctor about the best plan for your child. Treatment of AML usually involves 2 phases:

• Remission induction therapy—to kill leukemia cells
• Maintenance therapy—to kill any remaining leukemia cells that could grow and cause a relapse

Treatment options include:

• Chemotherapy
• External beam radiation therapy —targets a certain part of the body
• Stem cell transplant to replaces the affected bone marrow with healthy bone marrow
• Other drug therapy may be used to kill leukemia cells, stop them from dividing, or help them mature into white blood cells
• Biological therapy—involves using medicine or substances made by the body to increase or restore the body’s natural defenses against cancer
• Antibiotics to treat and prevent infections
• Medications to treat anemia and treatment side effects, such as like nausea and vomiting

Prevention

There are no current guidelines to prevent AML because the cause is unknown.

The Leukemia and Lymphoma Society http://www.lls.org

Canadian Cancer Society http://www.cancer.ca

Childhood leukemia. American Cancer Society website. Available at:
http://www.cancer.org/acs/groups/cid/documents/webcontent/003095-pdf.pdf
Accessed November 28, 2014.

Leukemia in children. Boston Children’s Hospital website. Available at: h
http://www.childrenshospital.org/health-topics/conditions/leukemia
Accessed November 28, 2014.