Incidence:

AML is the second most common childhood leukemia after acute lymphoblastic leukemia (ALL).

Symptoms of acute myeloid leukemia

Signs and symptoms of AML may include:

• Fever
• Fatigue
• Infections
• Easy bruising and bleeding
• Frequent nosebleeds
• Pain in bones or joints
• Pain or feeling of fullness under the rib cage
• Swollen lymph nodes
• Poor appetite

Risk factors for acute myeloid leukemia

• Risk factors for AML in children include:
• Having a brother or sister, especially a twin, with leukemia
• Past treatment with chemotherapy or radiation
• Myelodysplastic syndrome
• People with certain inherited disorders may develop AML:
• Aplastic anemia
• Diamond-Blackfan syndrome
• Familial platelet disorder
• Fanconi anemia
• Li-Fraumeni syndrome
• Mismatch repair syndromes
• MonoMAC syndrome
• Rothmund-Thomson syndrome
• Schwachman-Diamond syndrome

Diagnosis of acute myeloid leukemia 

• The doctor will check general signs of health during a physical exam and health history. They will:
• Look for signs of disease such as lumps or anything else that seems unusual
• Examine the eyes, mouth, skin, and ears
• Feel the patient’s belly for signs of an enlarged spleen, liver, and lymph nodes
• Examine the testes in boys
• Ask about the child’s personal and family history. The doctor is looking for possible inherited conditions that have an increased risk of cancer.

Tests to diagnose AML in children also include:

• Blood tests (complete blood count and blood chemistry)
• Bone marrow tests
• Lumbar puncture to find out if cancer cells have spread to the brain or spinal cord
• Chest x-ray to see if cancer has formed a mass in the chest

Tests to identify subtype

• If cancer is found, doctors will do more tests to find out the cancer subtype. These tests look for tumor markers, changes in chromosomes, and certain genes and proteins

Types of acute myeloid leukemia in children

• AML has several subtypes. Knowing the subtype allows doctors to classify AML cases into low-risk or high-risk. This helps them select the best treatment.
• Treatment based on risk category is called risk-adapted therapy. It has led to increased cancer survival rates.
• Patients with high-risk forms of cancer may get the most aggressive therapy. Patients with low-risk cases may get lower-intensity treatment with fewer side effects.
• To learn more about AML subtypes, ask your child’s doctor.

Treatment of acute myeloid leukemia 

• Treatment depends on the type of AML. Three forms of AML are treated differently than other forms of AML. These types are:
• Acute promyelocytic leukemia (APL)
• AML in children with Down syndrome
• FLT3-mutated AML
• Chemotherapy is the most common AML treatment. Stem cell transplant (also called bone marrow transplant or hematopoietic cell transplant) may also be an option.

AML treatment timeline

Week 1

• Diagnostic workup, treatment prep
• Doctors gather details to inform treatment.
• Blood tests
• Physical exam and history
• Chest x-ray
• Bone marrow aspirate and/or biopsy
• Lumbar puncture

4-6 weeks: Induction phase

• Induction therapy usually includes antibiotics plus a combination of drugs such as cytarabine and daunorubicin. Etoposide or gemtuzumab ozogamicin may also be given during induction therapy.
• The goal of this phase is to destroy leukemia cells in the blood and bone marrow and bring the disease into remission.
• AML patients have a high risk of infection. So your child will get antibiotics.
• Central nervous system (CNS) therapy (also called CNS prophylaxis) is also given during this time. It kills leukemia cells that remain in the brain and spinal cord. This prevents the spread of leukemia cells to those sites. Medicines are injected into the fluid-filled space between layers of tissue that cover the brain and spinal cord (intrathecal).
• Doctors will likely look at how well induction chemotherapy worked to decide if a stem cell transplant (bone marrow transplant) is needed. Patients and families may undergo a process to find possible donors in case the patient needs a transplant.
• Most pediatric centers use highly sensitive tests to measure for minimal residual disease (MRD). Positive MRD means a greater risk of relapse and need for more intensive therapy.

• The consolidation phase starts after the patient is in remission. The goal of this phase is to destroy any leukemia cells that remain.
• It includes 2–4 cycles of chemotherapy. It lasts 4–6 months.
• The goal of this phase is to kill any remaining leukemia cells that could grow and cause the cancer to come back (relapse). Cancer centers can perform tests that can detect a single AML cell among 1,000 normal cells. Children with more than 1 AML cell in 1,000 bone marrow cells after completing the induction phase are at a higher risk of relapse compared to patients with no detectable leukemia cells in their bone marrow.
• Some patients may get stem cell transplants at this stage.
• Doctors may suggest a transplant for a child who is at high risk for relapse or whose AML resists treatment. Doctors sometimes look at how well induction chemotherapy worked to decide whether a bone marrow transplant is needed.
• A transplant patient will be in the hospital for several weeks. It will likely be a year before the patient can return to school. 

Follow-up schedule

Year 1

• The patient returns for follow-up visits once every few months.
• These visits may include:
• Blood tests and other lab tests
• Bone marrow tests if needed
• Physical exam and medical history

Year 2

• Follow-up visits will occur less often.

Year 3-5

• Follow-up visits may change to once a year.