Childhood AML treatment

How is AML treated in children?

AML usually progresses quite quickly so treatment needs to begin as soon as it is diagnosed. Children diagnosed with AML need to be treated in a specialist paediatric referral centre under the care of a specialist doctor called a paediatric haematologist/oncologist.

The type of protocol your child is allocated to will depend on the ‘risk group’ to which they belong. The risk group to which they belong will be defined based on a number of clinical and laboratory factors, both at diagnosis and during treatment, that predict the outcomes of particular treatment approaches.

Sometimes adjustments need to be made to your child’s protocol depending on how well they are responding to treatment. It is important to realise that whatever protocol your child follows, it is the best treatment known against AML at the time.

Induction Treatment

Chemotherapy is the main form of treatment given for AML. Initially the aim of treatment is to destroy leukaemic cells and induce a remission. This means that there is no evidence of leukaemic cells in the blood and bone marrow and that normal blood cell production and normal blood counts are restored. In remission there is a small chance that some residual cells may still exist and therefore further cycles of treatment are given to reduce the chance of relapse. This is called post-remission or consolidation therapy.

Chemotherapy is usually given as a combination of drugs, which make up different courses of treatment usually given over a period of a week or so. Further courses of chemotherapy are given but are spaced out by three or four weeks. In most cases the drugs are given as infusions through a special line called a central venous catheter, which will be inserted before your child starts treatment. A central venous catheter is a special line inserted through the skin into a large vein in their arm, neck or chest.

Once in place, chemotherapy and other drugs can be given through the line and blood tests can also usually be taken from the line without the need for frequent needle pricks. There are several different kinds of central lines used. Some are intended for short-term use while others can remain in place for months or even years.

At the end of induction treatment a bone marrow test will be undertaken to examine the bone marrow for evidence of leukaemic cells.

Post remission/consolidation treatment

The consolidation protocol chosen for your child will depend on their estimated risk of relapse in the future and their response to their induction treatment. Children are categorised as having low, standard or high-risk AML. This ensures that the most appropriate and effective ‘risk-based’ therapy can be chosen for every child.

The purpose of consolidation is to prevent relapse. If your child is standard or good risk then further cycles of chemotherapy are given to destroy any remaining leukaemic cells. This may be a further two to three cycles of chemotherapy treatment.

For high-risk children, consolidation treatment may be further blocks of chemotherapy treatment or a stem cell transplant from a matched donor.

Bone marrow/stem cell transplant

Transplantation of donor stem cells is a treatment option following chemotherapy for patients whose AML is at high risk for relapse. Stem cell transplant is also a treatment option if your child’s AML relapses post-chemotherapy treatment. Further information on allogeneic (donor) transplants can be found on our transplant page.

Central nervous system treatment and prophylaxis

Leukaemic cells are sometimes found in the central nervous system (CNS – brain and spinal cord) at the time of diagnosis. In other cases AML reappears or relapses within this area at a later stage. Because the blood supply to the CNS is different from the blood supply to other parts of the body, this area can act as a ‘sanctuary site’ or hiding spot for leukaemic cells.  

CNS treatment and prophylaxis (protection) will be given at various stages throughout your child’s treatment. This usually involves injections of chemotherapy drugs directly into the spinal fluid (intrathecal injection), through a lumbar puncture. Some types of intravenous chemotherapy and cortico-steroid therapy also provide valuable protection for the CNS.

On rare occasions, radiation therapy to the head (cranial irradiation) is also used.

Relapse

Eighty percent of children with AML will go into remission and 50-60 % of those diagnosed will remain disease-free following their initial remission. Finding out that your child’s leukaemia has relapsed can be devastating, but there are generally a number of options to try that can get the leukaemia under control.

The treatment of relapsed disease depends on a number of factors including the duration of the remission and the site at which the disease has reappeared. Other factors are also considered including your child’s age and the genetic make-up of the relapsed leukaemic cells. Similar drugs to those used to initially treat leukaemia, different drugs, and in some cases high dose chemotherapy and a stem cell transplant may be used to treat relapsed disease. Your child’s treating specialist will discuss all the treating options available to your child.