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\nChildhood acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. AML is also called acute myelogenous leukemia and acute nonlymphocytic leukemia. Cancers that are acute usually get worse quickly if they are not treated. Cancers that are chronic usually get worse slowly.
\n \nThis summary is about the treatment of childhood AML, transient abnormal myelopoiesis, childhood acute promyelocytic leukemia, juvenile myelomonocytic leukemia, childhood chronic myelogenous leukemia, and childhood myelodysplastic syndromes. For information about the treatment of childhood acute lymphoblastic leukemia, see Childhood Acute Lymphoblastic Leukemia Treatment.
\nIn healthy children, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. A lymphoid stem cell becomes a type of white blood cell.
\nA myeloid stem cell becomes one of three types of mature blood cells:
\nIn AML, the myeloid stem cells usually become a type of immature white blood cell called myeloblasts (or myeloid blasts). The myeloblasts, or leukemia cells, in AML are abnormal and do not become healthy white blood cells. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, or easy bleeding.
\nThe leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums. Sometimes leukemia cells form a solid tumor called a myeloid sarcoma. Myeloid sarcoma is also called granulocytic sarcoma or chloroma.
\nTAM is a disorder of the bone marrow that can develop in newborns who have Down syndrome. TAM usually goes away on its own within the first 3 months of life. Infants who have TAM have an increased chance of developing AML before the age of 3 years. TAM is also called transient myeloproliferative disorder or transient leukemia.
\nAPL is a subtype of AML. In APL, some genes on chromosome 15 switch places with some genes on chromosome 17 and an abnormal gene called PML-RARA is made. The PML-RARA gene sends a message that stops promyelocytes (a type of white blood cell) from maturing. The promyelocytes (leukemia cells) can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. Problems with severe bleeding and blood clots may also occur. This is a serious health problem that needs treatment as soon as possible.
\nJMML is a rare childhood cancer that is most common in children around the age of 2 years and is more common in boys. In JMML, too many myeloid blood stem cells become myelocytes and monocytes (two types of white blood cells). Some of these myeloid blood stem cells never become mature white blood cells. These immature cells, called blasts, are unable to do their usual work. Over time, the myelocytes, monocytes, and blasts crowd out the healthy white blood cells, red blood cells, and platelets in the bone marrow. When this happens, infection, anemia, or easy bleeding may occur.
\nCML often begins in an early myeloid blood cell when a certain gene change occurs. A section of genes, that includes the ABL gene, on chromosome 9 changes place with a section of genes on chromosome 22, which has the BCR gene. This makes a very short chromosome 22 (called the Philadelphia chromosome) and a very long chromosome 9. An abnormal BCR-ABL gene is formed on chromosome 22. The BCR-ABL gene tells the blood cells to make too much of a protein called tyrosine kinase. Tyrosine kinase causes too many abnormal white blood cells (leukemia cells) to be made in the bone marrow. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. This can lead to infection, anemia, or easy bleeding. CML is rare in children.
\n \nMDS occur less often in children than in adults. In MDS, the bone marrow makes too few red blood cells, white blood cells, and platelets. These blood cells may not mature and enter the blood. The type of MDS depends on the type of blood cell that is affected.
\nThe treatment for MDS depends on how low the numbers of red blood cells, white blood cells, or platelets are. Over time, MDS may become AML.
\nCancer treatment with certain chemotherapy drugs and/or radiation therapy may cause therapy-related AML (t-AML) or therapy-related MDS (t-MDS). The risk of these therapy-related myeloid diseases depends on the total dose of the chemotherapy drugs used and the radiation dose and treatment field. Some patients also have an inherited risk for t-AML and t-MDS. These therapy-related diseases usually occur within 7 years after treatment, but are rare in children.
\nAnything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn\u2019t mean that you will not get cancer. Talk with your child\u2019s doctor if you think your child may be at risk. These and other factors may increase the risk of childhood AML, APL, JMML, CML, and MDS:
\nThese and other signs and symptoms may be caused by childhood AML, APL, JMML, CML, or MDS or by other conditions. Check with a doctor if your child has any of the following:
\nThe signs and symptoms of TAM may include the following:
\nSometimes TAM does not cause any symptoms at all and is diagnosed after a routine blood test.
\nThe following tests and procedures may be used:
\nThe following test is a type of cytogenetic analysis:
\nThe prognosis and treatment options for childhood acute myeloid leukemia (AML) depend on the following:
\nThe prognosis and treatment options for childhood acute promyelocytic leukemia (APL) depends on the following:
\nThe prognosis and treatment options for juvenile myelomonocytic leukemia (JMML) depend on the following:
\nThe prognosis and treatment options for childhood chronic myelogenous leukemia (CML) depend on the following:
\nThe prognosis and treatment options for myelodysplastic syndromes (MDS) depend on the following:
\nThe extent or spread of cancer is usually described as stages. Instead of stages, treatment is based on one or more of the following:
\nNewly diagnosed childhood AML
\nNewly diagnosed childhood AML is cancer that has not been treated except to relieve signs and symptoms such as fever, bleeding, or pain, and has one of the following:
\nor
Childhood AML in remission
\nIn childhood AML in remission, the disease has been treated and the following are found:
\nRefractory leukemia is cancer that does not respond to treatment.
\nRecurrent leukemia is cancer that has recurred (come back) after it has been treated. The cancer may come back in the blood and bone marrow or in other parts of the body, such as the central nervous system (brain and spinal cord).
\nDifferent types of treatment are available for children with acute myeloid leukemia (AML), transient abnormal myelopoiesis (TAM), acute promyelocytic leukemia (APL), juvenile myelomonocytic leukemia (JMML), chronic myelogenous leukemia (CML), and myelodysplastic syndromes (MDS). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
\nBecause AML and other myeloid disorders are rare in children, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not yet started treatment.
\nTreatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other healthcare providers who are experts in treating children with leukemia and who specialize in certain areas of medicine. These may include the following specialists:
\nThe treatment of childhood AML is done in phases:
\nTreatment called central nervous system (CNS) prophylaxis therapy may be given during the induction phase of therapy. Because standard doses of chemotherapy may not reach leukemia cells in the CNS (brain and spinal cord), the leukemia cells are able to hide in the CNS. Intrathecal chemotherapy is able to reach leukemia cells in the CNS. It is given to kill the leukemia cells and lessen the chance the leukemia will recur (come back).
\nThe treatment of childhood APL includes a third phase called maintenance. The goal of maintenance is to kill any remaining leukemia cells that may regrow and cause a relapse. Often the cancer treatments are given in lower doses than those used during the remission induction and consolidation/intensification phases.
\nChemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one chemotherapy drug.
\nThe way the chemotherapy is given depends on the type of cancer being treated. In AML, chemotherapy given by mouth, vein, or into the cerebrospinal fluid is used.
\nIn AML, the leukemia cells may spread to the brain and/or spinal cord. Chemotherapy given by mouth or vein to treat AML may not cross the blood-brain barrier to get into the fluid that surrounds the brain and spinal cord. Instead, chemotherapy is injected into the fluid-filled space to kill leukemia cells that may have spread there (intrathecal chemotherapy).
\n \nSee Drugs Approved for Acute Myeloid Leukemia for more information.
\nRadiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
\nIn childhood AML, external radiation therapy may be used to treat a myeloid sarcoma that does not respond to chemotherapy.
\nChemotherapy is given to kill cancer cells or other abnormal blood cells. Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and given to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
\n \nTargeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Types of targeted therapy include the following:
\nSee Drugs Approved for Leukemia for more information.
\nLenalidomide may be used to lessen the need for transfusions in patients who have myelodysplastic syndromes caused by a specific chromosome change.
\nArsenic trioxide and tretinoin are drugs that kill certain types of leukemia cells, stop the leukemia cells from dividing, or help the leukemia cells mature into white blood cells. These drugs are used in the treatment of acute promyelocytic leukemia.
\nSee Drugs Approved for Acute Myeloid Leukemia for more information.
\nWatchful waiting is closely monitoring a patient\u2019s condition without giving any treatment until signs or symptoms appear or change. It is sometimes used to treat transient abnormal myelopoiesis (TAM).
\nSupportive care is given to lessen the problems caused by the disease or its treatment. All patients with leukemia receive supportive care treatments. Supportive care may include the following:
\nThis summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
\nTo learn more about side effects that begin during treatment for cancer, visit Side Effects.
\nRegular follow-up exams are very important. Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:
\nSome late effects may be treated or controlled. It is important that parents of children who are treated for AML or other blood diseases talk with their child's doctors about the effects cancer treatment can have on their child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).
\nFor some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
\nMany of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
\nPatients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
\nSome clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
\nClinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI\u2019s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
\nAs your child goes through treatment, they will have follow-up tests or checkups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. These tests are sometimes called follow-up tests or check-ups.
\nSome of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back).
\nFor information about the treatments listed below, see the Treatment Option Overview section.
\nTreatment of newly diagnosed childhood acute myeloid leukemia (AML) during the induction phase may include the following:
\nTreatment of childhood AML during the remission phase (consolidation/intensification therapy) depends on the subtype of AML and may include the following:
\nTreatment of refractory childhood AML may include the following:
\nTreatment of recurrent childhood AML may include the following:
\nFor information about the treatments listed below, see the Treatment Option Overview section.
\nTransient abnormal myelopoiesis (TAM) usually goes away on its own. For newly diagnosed TAM that does not go away on its own or causes other health problems, treatment may include the following:
\nTreatment of newly diagnosed acute myeloid leukemia (AML) in children aged 4 years or younger who have Down syndrome may include the following:
\nTreatment of newly diagnosed AML in children older than 4 years who have Down syndrome may be the same as treatment for children without Down syndrome.
\nFor information about the treatments listed below, see the Treatment Option Overview section.
\nTreatment of newly diagnosed childhood acute promyelocytic leukemia (APL) may include the following:
\nTreatment of childhood APL during the remission phase (consolidation/intensification therapy) may include the following:
\nTreatment of childhood APL during the remission phase (maintenance therapy) may include the following:
\nTreatment of recurrent childhood APL may include the following:
\nFor information about the treatments listed below, see the Treatment Option Overview section.
\nTreatment of newly diagnosed juvenile myelomonocytic leukemia (JMML) may include the following:
\nTreatment of refractory or recurrent childhood JMML may include the following:
\nFor information about the treatments listed below, see the Treatment Option Overview section.
\nTreatment of newly diagnosed chronic myelogenous leukemia (CML) may include the following:
\nTreatment of refractory or recurrent childhood CML may include the following:
\nFor information about the treatments listed below, see the Treatment Option Overview section.
\nTreatment of newly diagnosed childhood myelodysplastic syndromes (MDS) may include the following:
\nIf the MDS becomes acute myeloid leukemia (AML), treatment will be the same as treatment for newly diagnosed AML.
\nFor more information from the National Cancer Institute about childhood acute myeloid leukemia and other myeloid malignancies, see the following:
\nFor more childhood cancer information and other general cancer resources, visit:
\nPhysician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
\nPDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government\u2019s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
\nThis PDQ cancer information summary has current information about the treatment of childhood acute myeloid leukemia and other myeloid malignancies. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
\nEditorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (\"Updated\") is the date of the most recent change.
\nThe information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.
\nA clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become \"standard.\" Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
\nClinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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\nThe best way to cite this PDQ summary is:
\nPDQ\u00ae Pediatric Treatment Editorial Board. PDQ Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/leukemia/patient/child-aml-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389303]
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