Acute myeloid leukemia (AML) - children

In children, AML is rare.

AML involves cells in the bone marrow that usually become certain types of white blood cells. These leukemia cells build up in the bone marrow and blood, leaving no space for healthy white blood cells, red blood cells, and platelets to form. Because there are not enough healthy cells to do their jobs, children with AML are more likely to have:

• Anemia (low level of red blood cells)
• Increased risk for bleeding and bruising
• Infections

Most of the time, the cause of AML is unknown. In children, some things can increase the risk of developing AML:

• Exposure to alcohol or tobacco smoke before birth
• A history of certain diseases, such as aplastic anemia
• Certain genetic disorders, such as Down syndrome, neurofibromatosis, and other rare syndromes
• Previous use of certain chemotherapy medicines such as cyclophosphamide
• Past treatment with radiation therapy

Having one or more risk factor does not mean your child will develop cancer. Most children who develop AML have no known risk factors.

Symptoms of AML include:

• Feeling weak or tired
• Bone or joint pain
• Frequent infections
• Easy bleeding or bruising
• Fever with or without an infection
• Night sweats
• Painless lumps in the neck, armpits, stomach, groin, or other parts of the body that may be blue or purple
• Pinpoint red spots (petechiae) under the skin caused by bleeding
• Shortness of breath
• Loss of appetite and eating less food

Your child's health care provider will perform the following exams and tests:

• Physical exam and health history
• Complete blood count (CBC) and coagulation assay
• Blood chemistry study including kidney function tests, and uric acid level
• Chest x-ray
• Lumbar puncture to look for leukemia cells in the cerebrospinal fluid
• Biopsies of the bone marrow, or lymph node
• A test to look for changes in the chromosomes in blood or bone marrow

Other tests may be done to determine the specific type of AML.

Treatment for children with AML may include:

• Anticancer medicines (chemotherapy)
• Certain types of targeted therapy

Bone marrow transplant is used if the leukemia returns after treatment or doesn't respond well to initial therapy with chemotherapy. This process uses high doses of chemotherapy and sometimes radiation therapy to treat the leukemia followed by transfusion of bone marrow from a compatible donor.

Supportive care includes red blood cell and platelet (a blood element that helps to stop bleeding) transfusions.

Your child's treatment team will explain the different options to you. You will want to take notes. Be sure to ask questions if you don't understand something.

Having a child with cancer can make you feel very alone. Joining a support group where other parents or families share common experiences may help ease your stress.

• Leukemia and Lymphoma Society -- www.lls.org
• The National Children’s Cancer Society -- thenccs.org/

Cancer can come back at any time. But for most children, AML doesn't come back after being gone for 5 years. However, there is a wide range in outcomes for different subtypes of AML, and the disease might return.

The leukemia cells can affect various organs in the body including:

• Brain
• Kidneys
• Lungs
• Skin
• Intestines

As a result of the treatment, it's common to experience:

• Fatigue
• Hair loss
• Weight loss
• Mouth sores
• Need for transfusions
• Infections requiring hospitalization
• Infertility
• Severe organ damage (very rarely)

Contact your child's provider for an appointment right away if your child develops these symptoms:

• Persistent fever
• Easy bruising
• Shortness of breath
• Viral infection that doesn't resolve
• Prolonged fatigue
• Any other symptoms of AML

Many childhood cancers can't be prevented. Most children who develop leukemia have no risk factors.

Acute myelogenous leukemia - children; AML - children; Acute granulocytic leukemia - children; Acute myeloblastic leukemia - children; Acute non-lymphocytic leukemia (ANLL) - children

American Cancer Society website. What is childhood leukemia? www.cancer.org/cancer/types/leukemia-in-children/about/what-is-childhood-leukemia.html. Updated February 12, 2019. Accessed August 22, 2024.

National Cancer Institute website. Childhood acute myeloid leukemia treatment (PDQ) - health professional version. www.cancer.gov/types/leukemia/hp/child-aml-treatment-pdq. Updated June 14, 2024. Accessed August 22, 2024.

Redner A, Kessel R. Acute myeloid leukemia. In: Fish JD, Lipton JM, Lanzkowsky P, eds. Lanzkowsky's Manual of Pediatric Hematology and Oncology. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 19.

Zwaan CM, Heidenreich O, Kolb EA. Acute myeloid leukemia in children. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 63.

Updated by: Rachel Offenbacher, MD, Pediatric Hematology & Oncology, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.