What is AML?

Acute myeloid leukaemia (AML) is the less common form of childhood leukaemia. It presents with an excessive growth of abnormal, immature white blood cells called myeloblasts. This occurs in the bone marrow, which is the site of all normal blood cell production (red blood cells, platelets and various types of white blood cells). The acute prefix means that the disease can progress rapidly, while a chronic type of disease develops slowly. The uncontrolled growth of leukaemic myeloblasts can replace the normal blood cells in the bone marrow and from there they can spread into the bloodstream. Myeloblasts have the potential to spread to other organs of the body such as the liver, spleen and lymph glands.

Signs and symptoms

Children with AML can present with a variety of symptoms namely pallor, lethargy, fever, easy bruising, pain in the bones or joints, swollen glands and/or weight loss. Some children often present with extramedullary disease presenting with skin lesions or swollen eyes (proptosis).

Diagnosis

A full blood examination suggests the diagnosis of AML but a bone marrow aspirate is necessary to confirm the diagnosis. Other blood tests, a lumbar puncture and chest X-ray will also be done.

Treatment

Chemotherapy is the primary mode of treatment for AML. Often there are clinical trials open which your child may be eligible to participate in. Treatment lasts about six months and is divided into a number of phases. Two courses of induction therapy are followed by 2-3 courses of intensification therapy. Chemotherapy is given orally, intravenously, intramuscularly, subcutaneously and intrathecally. All courses of therapy are given as an inpatient. As the therapy is more intensive to that of therapy for ALL, there is an increased incidence of prolonged hospital admissions and requirements for blood and platelet infusions and antibiotics for fever and infections.

Depending upon certain clinical, laboratory and molecular features present at diagnosis and on early response to therapy, stem cell transplantation may be necessary if a suitable donor is available.

Follow-up care

Once therapy is completed, there is a regular schedule of follow up care, to monitor for disease recurrence and the continued growth and development of the child.