This information is intended to provide a general overview of Childhood Acute Myeloid Leukaemia (AML). It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.
Leukaemia is the umbrella term for cancers that affect the blood and the blood-forming tissues within the body. While it is considered a rare disease, paediatric Acute Myeloid Leukaemia (AML) is the second most commonly diagnosed type of leukaemia in children.
The body is constantly producing millions of new blood cells every day, with the process primarily occurring in the bone marrow, the spongy tissue found inside bones that houses immature stem cells. In a healthy individual, these immature stem cells develop into two main types:
These mature into white blood cells, which are crucial for the immune system. They first become immature cells called lymphoblasts and then mature into various types of lymphocytes, such as B cells (which produce antibodies to fight bacteria and viruses) and T cells (which alert other immune cells and fight infections directly).
These also develop into certain white blood cells (like monocytes and granulocytes, including neutrophils, which fight disease), as well as red blood cells (which carry oxygen) and platelets (which help blood to clot).
Leukaemia occurs when the genetic instructions (DNA) within a bone marrow stem cell mutate at some point during its development. This cell becomes cancerous, begins to multiply uncontrollably, and quickly overwhelms the healthy cells in the blood and bone marrow. These diseased cells can also build up in other areas of the body, such as the liver, lymph nodes, spleen, and skin.
Leukaemias are broadly classified based on the type of stem cell that becomes cancerous (either lymphoid or myeloid) and the speed of the disease's progression:
This involves immature cells, preventing them from developing correctly and performing their function. These cells multiply rapidly, making acute leukaemia more aggressive. Almost all childhood leukaemias are acute.
This involves mature or partially mature cells that multiply more slowly, making it less aggressive than the acute form. Chronic leukaemia is rare in children.
AML develops from myeloid stem cells. It occurs after a myeloid stem cell develops into a myeloblast, which should mature into a healthy white blood cell. However, in AML, the cell mutates into a leukaemic cell and cannot develop normally. These diseased cells are unable to function properly and multiply rapidly, crowding out healthy blood cells as the disease progresses.
As a result, AML, like other leukaemias, can lead to:
AML has several subtypes, many of which depend on specific chromosome abnormalities and the types of molecules produced by the cancer cells. These specific subtypes are important factors that guide the patient's treatment plan and outlook.
A risk factor is anything that increases the chance of developing a disease. It is important to note that the presence of risk factors does not mean a child will definitely develop AML. Risk factors for childhood AML include:
While there are many different types of leukaemia, the symptoms they cause can be similar. Many symptoms arise from a lack of properly functioning blood cells, which are necessary to carry oxygen, fight infection, and stop bleeding. Some symptoms may also be due to low levels of haemoglobin, the protein that moves oxygen through the body.
Successful leukaemia treatment starts with an accurate and precise diagnosis. At SSCHRC, our suspected leukaemia cells are examined by pathologists who specialise exclusively in diagnosing leukaemia and its many subtypes. This focused expertise allows SSCHRC to offer patients the most effective treatment for their specific disease.
A leukaemia diagnosis usually begins with a simple blood test called a CBC. A doctor may order this test after evaluating a patient's symptoms, or it may be part of a routine check-up. If the test shows the presence of leukaemia cells or abnormal levels of red blood cells, white blood cells, or platelets, further tests may be ordered.
For leukaemia, patients undergo a bone marrow biopsy. This involves taking a sample of bone marrow from the hip with a needle to determine if cancerous cells are present. The retrieved suspected cancer cells are then studied under a microscope.
If leukaemia is diagnosed, additional tests can determine if specific chromosomes or gene mutations are present in the diseased cells, or if they have specific proteins or molecules on their surface. This process helps doctors determine the patient's exact type of leukaemia and their prognosis, which is vital for creating a treatment plan with the best chance of success, as cancers with different genetic features may respond differently to treatments.
While leukaemia starts in the bone marrow, it can potentially spread to the central nervous system (the brain and spinal cord). A lumbar puncture is used to check for this spread by examining the patient's spinal fluid. During the procedure, a needle is used to remove cerebrospinal fluid from the spine. A small dose of chemotherapy may also be administered into the spinal fluid to kill any leukaemia cells that may be present.
Doctors may order imaging exams to check for the presence of cancer in different parts of the body.
Since there is no standard staging system for AML, the disease is described by the patient's treatment and disease status:
Cancer that has not been treated (except to relieve symptoms like fever, bleeding, or pain) and has one of the following:
The disease has been treated, and the following are found:
Cancer that does not respond to treatment.
Cancer that has returned (come back) after it has been treated. The cancer may return in the blood, bone marrow, or in other parts of the body, such as the central nervous system.
At SSCHRC, we understand that your child's health and well-being are your highest priority. Our renowned experts tailor your child's leukaemia care using the most advanced treatments and techniques with the least impact on your child's growing body. As part of one of the world's most active cancer centres, SSCHRC has exceptional experience and skill in treating these cancers, which can make a significant difference to your child's outcome.
A team of specially trained physicians manages your child's care throughout treatment, all the way to survivorship. They communicate closely with each other and with you to ensure comprehensive, personalised care. They are supported by a full complement of healthcare professionals dedicated to your child's treatment, including nurses, physician assistants, and therapists. SSCHRC offers clinical trials for innovative new treatments for leukaemia and is involved in groundbreaking basic science research to change the future of paediatric cancer.
Treatment for newly diagnosed childhood AML patients typically focuses on chemotherapy. Stem cell transplantation is also an important treatment option for AML. It may be an initial treatment for patients with particularly aggressive and hard-to-treat types of the disease. It is also given to patients with refractory AML (meaning the disease has not responded to standard treatments) or recurrent AML (meaning the disease has returned after remission). These patients can only undergo a stem cell transplant after achieving remission with non-standard or experimental therapies.
Chemotherapy drugs kill cancer cells, control their growth, or help relieve disease-related symptoms. Treatment may involve a single drug or a combination of two or more drugs, depending on the type of cancer and its growth rate.
Chemotherapy for AML is usually given in two stages:
Patients will also receive a small dose of chemotherapy into their central nervous system to prevent the disease from spreading to this area. Patients preparing for a stem cell transplant may also undergo chemotherapy to prepare their body for the procedure.
Targeted therapy drugs are designed to stop or slow the growth or spread of cancer at a cellular level. Cancer cells need specific molecules (often proteins) to survive and multiply. Targeted therapies are designed to interfere with, or 'target', these molecules or the cancer-causing genes that create them.
A stem cell transplant (also known as a bone marrow transplant) is a procedure that replaces cancerous bone marrow with new, healthy bone marrow stem cells. Transplants are typically given after an intense round of chemotherapy that destroys the patient's existing bone marrow cells. Patients usually need to stay in the hospital for three to four weeks after the procedure.
A stem cell transplant may be necessary for patients whose leukaemia has returned or has not responded to standard treatments. It may also be recommended if the patient has a high-risk form of leukaemia where a cure with standard treatments is unlikely. This is a physically challenging treatment, so it is typically not administered to patients who are older or otherwise unhealthy.
Radiation therapy uses powerful beams of energy to kill cancer cells. Since leukaemia cells travel in the bloodstream, there is no distinct tumour to target like there is with other cancers. Instead, radiation is typically used when the disease has spread to the central nervous system.
As a top-ranked cancer centre, SSCHRC offers multiple clinical trials for AML. Many of these trials are unique and cannot be accessed elsewhere. Trials explore new drug combinations and new drugs, including targeted therapies and immunotherapies.