Hematologic Malignancies Program

Childhood Acute Myeloid Leukemia

Treatment Phases

There is no staging for childhood acute myeloid leukemia (AML). The disease is always spread throughout the bloodstream at the time of diagnosis and sometimes invades other body tissues. The choice of treatment is based on whether or not the child has been treated previously and on the current status of the disease.

Untreated AML

Untreated childhood acute myeloid leukemia means that no treatment has been given except to treat symptoms. There are too many white blood cells in the blood and bone marrow, and there may be other signs and symptoms of leukemia. In rare cases, acute myeloid leukemia tumor cells appear as a solid tumor called an isolated granulocytic sarcoma or chloroma.

The child's treatment will probably be induction chemotherapy using two or more chemotherapy drugs to kill cancer cells and cause the leukemia to go into remission. Intrathecal chemotherapy with or without radiation therapy to the brain may be given to prevent the spread of cancer cells to the brain and spinal cord. Biological therapy may be added to treatment to help the child recover more quickly from the side effects of induction therapy.

AML in remission

Remission means that treatment has been given and that the numbers of white blood cells and other blood cells in the blood and bone marrow are approaching normal following initial treatment with chemotherapy. There are no signs or symptoms of leukemia. Treatment will consist of additional chemotherapy or bone marrow transplantation. Central nervous system prophylaxis and/or maintenance chemotherapy may also be given in some cases.

Recurrent/refractory AML

Recurrent disease means that the leukemia has come back (recurred) after going into remission. Refractory disease means that the leukemia has failed to go into remission following treatment. Treatment depends on the type of treatment the child received before. Parents may want to consider entering their child into a clinical trial. Treatments currently being studied in clinical trials include new chemotherapy drugs, bone marrow transplantation, and biological therapy.

Phases

Treatment for childhood acute myeloid leukemia is ordinarily divided into two phases: induction and consolidation. A third phase, intensification, may also be used. During induction therapy, chemotherapy is used to kill as many of the leukemia cells as possible so that the leukemia will go into remission. Once the leukemia goes into remission and there are no signs of leukemia, consolidation therapy is given. The purpose of postremission therapy (consolidation and intensification) is to kill any remaining leukemia cells. The child may receive either or both phases of postremission therapy.

As a preventive therapy, the child may also receive central nervous system (CNS) prophylaxis, which consists of intrathecal and/or high-dose systemic chemotherapy to the central nervous system to kill any leukemia cells present there. It is also intended to prevent the spread of cancer cells to the brain and spinal cord, even if no cancer has been detected. Radiation therapy to the brain may also be given in addition to chemotherapy for this purpose.

This page was last updated on: March 3, 2008.