 |
|
 |
|
300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
|
|
|
|
|
My Child Has:
|
|
Acute Myelogenous Leukemia
|
|
|
|
|
|
|
Leukemia is cancer of the blood. It develops in the bone marrow, the soft, spongy center of the long bones that produces the three major blood cells: white blood cells to fight infection; red blood cells that carry oxygen; and platelets that help blood clot and stop bleeding.
When a child has leukemia, the bone marrow, for an unknown reason, begins to make white blood cells that do not mature correctly, but continue to reproduce themselves. Normal, healthy cells only reproduce when there is enough space for them to fit. The body can regulate the production of cells by sending signals when to stop. With leukemia, these cells do not respond to the signals to stop and reproduce, regardless of space available.
These abnormal cells reproduce very quickly and do not function as healthy white blood cells to help fight infection. When the immature white blood cells, called blasts, begin to crowd out other healthy cells in the bone marrow, the child experiences the symptoms of leukemia (i.e., infections, anemia, bleeding).
|
|
|
|
Acute myelogenous leukemia (AML), also called granulocytic, myelocytic, myeloblastic, or myeloid leukemia, accounts for about 20 percent of the childhood leukemias. Acute myelogenous leukemia is a cancer of the blood in which too many immature myeloid cells (myeloblasts), a type of white blood cell, are produced in the marrow and they do not mature correctly. The myeloblasts overproduce, thus, crowding out other normal blood cells. In addition, these immature white blood cells (myeloblasts) do not work properly to fight infection. In patients with AML, these cells are most commonly found in the bone marrow and blood, but can also appear in the spinal fluid and the skin. Rarely, they can form into solid tumors called chloromas.
The symptoms associated with acute leukemia usually occur over a short period of days to weeks.
As you read further below, you will find general information about AML. If you would like to view summary information about cancer first, see the cancer overview.
|
|
|
|
|
|
Leukemia is the most common form of cancer in childhood. It affects approximately 3,000 children each year in the US, accounting for about 30 percent of childhood cancers. Leukemia can occur at any age, although it is most commonly seen in children between 2 and 6 years of age. The disease occurs slightly more frequently in males than in females, and is more commonly seen in Caucasian children than in African-American children, or children of other races.
AML is less common that acute lymphoblastic leukemia, the most common form of leukemia in children, and accounts for approximately 20 percent of childhood leukemia.
|
|
|
|
|
|
The majority of childhood leukemias are acquired genetic diseases. This means that gene mutations and chromosome abnormalities in cells occur sporadically (by chance). The immune system plays an important role in protecting the body from diseases, and possibly cancer. An alteration or defect in the immune system may increase the risk for developing leukemia. Factors such as exposure to certain viruses, environmental factors, chemical exposures, and various infections have been associated with damage to the immune system.
Children with certain genetic syndromes, including Fanconi anemia, Bloom syndrome, Kostmann syndrome, and Down syndrome, are at a higher risk of developing AML than other children.
|
|
|
|
|
|
In addition to acute myelogenous leukemia (AML), there are other types of leukemia:
|
|
|
- acute lymphoblastic leukemia (ALL) - also called lymphocytic or lymphoid, accounts for about 75 to 80 percent of the childhood leukemias. In this form of the disease, the lymphocyte cell line is affected. The lymphocytes, a type of white blood cell, normally fight infection. With acute lymphoblastic leukemia, the bone marrow makes too many of these lymphocytes and they do not mature correctly. The lymphocytes overproduce, thus crowding out other blood cells. In addition, these immature blood cells (blasts) do not work properly to fight infection. In some cases, these cancerous lymphocytes can affect the brain, spinal cord and other organs.
The difference between lymphoblastic and myelogenous is the types of white blood cell (lymphoid vs. myeloid) that has become disregulated in its growth.
Stem cell matures into either the lymphoid or myeloid cells. The lymphoid cells mature into either B-lymphocytes or T-lymphocytes. If the leukemia is among these cells, it is called acute lymphoblastic leukemia (ALL).
Acute myelogenous leukemia is also divided into subtypes. The disease is usually classified by the FAB system, which classifies the type of AML as M0 to M7. There is one subtype that receives different therapy from the others, called M3 AML (acute promyelocytic leukemia).
- chronic myelogenous leukemia (CML) - is uncommon in children. Chronic myelogenous leukemia is cancer of the blood in which too many immature white blood cells are produced in the marrow. The white blood cells normally fight infection. With this disease, the bone marrow makes too many of these cells and they do not mature correctly. The marrow continues to produce these abnormal cells which crowd out other healthy blood cells. Chronic myelogenous leukemia can occur over a period of months or years. A specific chromosome rearrangement is found in patients with CML. Part of chromosome #9 breaks off and attaches itself to chromosome #22, so that there is an exchange of genetic material between these two chromosomes. This rearrangement changes the position and functions of certain genes, which results in uncontrolled cell growth. Other chromosome abnormalities can also be present.
|
|
|
|
Because leukemia is cancer of the blood-forming tissue called the bone marrow, the initial symptoms are often related to irregular bone marrow function. The bone marrow is responsible producing the body's blood cells, including the red blood cells, white blood cells, and platelets.
When leukemia occurs, the abnormal white blood cells (blasts) begin to reproduce very rapidly and begin crowding out and competing for nutrients and space with the other healthy cells. The following are the most common symptoms of leukemia. However, each child may experience symptoms differently. Symptoms may include:
|
|
|
- anemia - when red blood cells are unable to be produced because of the crowding in the marrow, anemia is present. With anemia, the child may appear tired, pale, and may breathe faster to compensate for the decrease in oxygen carrying capacity. The number of red blood cells on a blood count will be below normal.
- bleeding and/or bruising - when platelets are unable to be produced because of the crowding in the marrow, bleeding can occur and the child may begin to bruise more easily. Petechia are tiny red dots often seen on the skin of a child with low number of platelets. Petechia are very small blood vessels that have "leaked" or bled. The number of platelets on a blood count will be below normal. Thrombocytopenia is the term used for a decreased number of platelets.
- recurrent infections - although there may be an unusually high number of white blood cells on a blood count of a child with leukemia, these white blood cells are immature and do not fight infection. The child may have had repetitive viral or bacterial infections over the past few weeks.
- bone and joint pain - pain in bones and joints is another common symptom of leukemia. This pain is usually a result of the bone marrow being overcrowded and "full."
- abdominal distress - abdominal pain may also be a symptom of leukemia. Leukemia cells can collect in the kidney, liver, and spleen, causing enlargement of these organs. Pain in the abdomen may cause a child to have loss of appetite and weight loss.
|
|
With AML, these symptoms usually occur over a number of days or weeks.
It is important to understand that the symptoms of leukemia may resemble other blood disorders or medical problems. These are common symptoms of the disease, but do not include all possible symptoms. Children may experience symptoms differently. Always consult your child's physician if you have concerns.
|
|
|
|
|
|
In addition to a complete medical history and physical examination, diagnostic procedures for leukemia may include:
|
|
|
- bone marrow aspiration and biopsy - marrow may be removed by aspiration or a needle biopsy under local anesthesia. In aspiration biopsy, a fluid specimen is removed from the bone marrow. In a needle biopsy, a core sample of bone and bone marrow is removed. These methods are often used together.
- complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in blood
- additional blood tests - may include blood chemistries, evaluation of liver and kidney functions, and genetic studies
- chromosomal analysis - additional tests that can help distinguish AML from ALL or other leukemias and help physicians tailor treatment to the specific disease
- spinal tap/lumbar puncture - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. Cerebral spinal fluid (CSF) is the fluid that bathes your child's brain and spinal cord. A small amount CSF can be removed and sent for testing to determine if leukemia is present.
|
|
|
|
Specific treatment for leukemia will be determined by your child's physician based on:
|
|
|
- your child's age, overall health, and medical history
- the extent of the disease
- your opinion or preference
|
|
Treatment usually begins by addressing the presenting symptoms such as anemia, bleeding, and/or infection. In addition, treatment for leukemia may include (alone or in combination) the following:
|
|
|
- chemotherapy - a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells and shrink tumors. Chemotherapy may be used alone for some types of cancer or in conjunction with other therapy such as radiation. Often, a combination of chemotherapy drugs is used to fight a specific cancer. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat. While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate some normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
- as an injection into the muscle or fat tissue
- intravenously (directly to the bloodstream; also called IV)
- intrathecally - chemotherapy given directly into the spinal column with a needle
- intrathecal medications/chemotherapy - medications are inserted through a needle into the spinal cord into the area called the subarachnoid space)
- radiation therapy - using high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors
- stem cell transplant - a treatment involving stem cells, a specific type of cell from which all blood cells develop. Stem cells develop into red blood cells to carry oxygen, white blood cells to fight disease and infection, and platelets to aid in blood clotting. Stem cells are found primarily in the bone marrow, but some also circulate in the blood stream.
Treatment begins with high-dose chemotherapy (perhaps combined with radiation therapy) to destroy all of the bone marrow, stem cells and cancerous cells, in the body. Then, healthy stem cells from another person is used to help restore normal blood production in the patient with AML. The use of stem cells from another individual whose tissue is the same as, or almost the same as, the patient's is called allogeneic transplantation.
- biological therapy - a wide range of substances that may be able to involve the body's own immune system to fight cancer or lessen harmful side effects of some treatments
- other medications - to prevent or treat damage to other systems of the body caused by leukemia treatment, for example, to prevent or treat nausea
- blood transfusions - red blood cells, platelets
- antibiotics - to prevent/treat infections
- continuous follow-up care - to determine response to treatment, detect recurrent disease, and manage late effects of treatment
|
|
|
|
There are various stages in the treatment of leukemia, including the following:
|
|
|
- induction -chemotherapy given to stop the process of abnormal cells being made in the bone marrow. Remission is the goal in this stage of treatment. Remission means the leukemia cells are no longer visible when a sample of the bone marrow is examined under a microscope. This phase may last approximately one month and can be repeated if the goal is not achieved.
- intensification - continued treatment even though leukemia cells may not be visible in a blood test or bone marrow examination, but it is possible that the cells are still present in the body. This may include chemotherapy given to the central nervous system to kill any leukemia cells present there, or to prevent the spread of leukemia cells to the spinal cord or brain. Radiation therapy may also be given to the brain during this phase.
|
|
|
|
Prognosis greatly depends on:
|
|
|
- the type of leukemia.
- disease response to treatment.
- your child's tolerance of specific medications, procedures, or therapies.
- new developments in treatment.
|
|
Relapse may occur even with aggressive therapy. Relapse is when the bone marrow begins making abnormal cells again. Relapse can occur during any of the stages of treatment, or may occur months or years after treatment has ended.
As with any cancer, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for the child diagnosed with leukemia. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of leukemia. New methods are continually being discovered to improve treatment and to decrease side effects of the treatment for the disease.
|
|
|
|
|
|
In the area of stem cell transplantation, the Dana-Farber/Children's Transplant Program is one of only eight institutions around the country that are investigating the use of umbilical cord transplantation. Also under study is a novel method for preventing graft versus host disease, a serious complication that occurs when transplanted cells do not recognize the tissues and organs of the recipient's body and react against the recipient's tissue. The result of this treatment approach, if it continues to be as successful, will be that the degree of match between donor and the recipient will not need to be particularly close, greatly increasing the pool of potential donors for each patient. This could also eliminate the need for long-term drug therapy traditionally needed to treat graft versus host disease.
Dana-Farber Cancer Institute and Children's Hospital are part of the Children's Oncology Group, a national group of pediatric oncologists who work together to carry out clinical trials in pediatric oncology patients. New drugs for CML are often available as part of research protocols through this group.
|
|
|
|
|
|
|
|
|
|
|
|
|
The information on this website should not be taken as medical advice,
which can only be given to you by your personal health care professional. |
|
|
|
Copyright © Children's Hospital Boston. All rights reserved. |
|
|
|
|
