Acute Myeloid Leukaemia

Leukaemia is a cancer of the white blood cells which begins in the bone marrow.

The bone marrow is the spongy tissue that is found in the middle of the bones which produces all of the body’s blood cells. There are three types of blood cell:

Red blood cells – which carry oxygen around the body.
White blood cells – which help fight infection.
Platelets – which help clot the blood, controlling bleeding and bruising.

Stem cells, or ‘mother’ blood cells, divide and grow within the bone marrow to become mature blood cells. When leukaemia occurs the bone marrow produces a large amount of immature rather than mature blood cells. The immature cells do not work properly as they have not yet grown to what they were supposed to be.

Leukaemia usually affects the production of white blood cells and is named after the type of cells that have been affected.

Acute Myeloid Leukaemia (AML) is named after the early white myeloid blood cells it affects.

Acute Lymphoblastic Leukaemia (ALL) is named after the early lymphoid white blood cells (known as lymphoblasts) it affects.

The immature white blood cells ‘squeeze out’ the production of healthy white blood cells which reduces the body’s ability to fight infection. Red blood cells and platelets are also reduced in numbers resulting in symptoms such as anaemia and bruising.

Acute Myeloid Leukaemia is a cancer that affects the myeloid white blood cells in the bone marrow.
 
AML has a number of sub-types based on how the leukaemic cells look compared to a mature myeloid cell.  It is important for doctors to know the sub-type of AML in order to formulate the best treatment plan. The types of AML are described below. Parents can ask their child’s consutant for further advice.

M0 Acute Myeloid Leukaemia with minimal evidence of myeloid differentiation
M1 Acute Myeloblastic Leukaemia without maturation
M2 Acute Myeloblastic Leukaemia with maturation
M3 Acute Promyelocytic Leukaemia (APL)
M4 Acute Myelomonocytic Leukaemia
M5 Acute Monocytic/monoblastic Leukaemia
M6 Acute Erythroleukaemia
M7 Acute Megakaryoblastic Leukaemia top of page

AML is a less common form of leukaemia, which affects both boys and girls in childhood. Under the age of two, it affects more girls than boys.

Anaemia – caused by the leukaemia cells 'crowding out' the production of healthy red blood cells and reducing their numbers. This will make the child tired, breathless and feel quite poorly.

Bruising and bleeding – caused by the reduced number of platelet cells produced within the bone marrow. These cells normally clot the blood.

Infections – caused by the lack of healthy white blood cells.

A blood test can reveal changes in the numbers of healthy white blood cells. A bone marrow aspirate (where a full sample of bone marrow is taken and tested) will also be necessary.

A lumbar puncture is also likely to be needed to see if the spinal fluid contains any leukaemia cells. Other tests may be necessary depending on the symptoms.

AML is treated mainly with chemotherapy, which aims to kill the leukaemia cells, allowing the bone marrow to work normally.

The treatment is given in phases:

Phase one aims to eliminate the leukaemia using a series of short but intensive cycles of treatment over a period of four to six months. If this happens the child is in remission. 

Because the treatment is intensive, many children will need to spend most of this time in hospital to receive special care aimed at reducing infections.   

Phase two aims to consolidate the initial treatment with two or more does of chemotherapy given once the child is in remission.

Chemotherapy drugs can also be used to catch any cells that have spread to the brain or spinal cord by injecting chemotherapy drugs into the spinal fluid. 

Most children with AML achieve remission. However for some children the leukaemia returns. In these cases further treatment can be offered, including a stem cell, or bone marrow transplant. There is general information about the procedure in our stem cell support section but as cases are likely to be highly individual, parents might want to talk to a member of their child’s care team about it.

Long-term side-effects
Some children do develop more long-term side-effects after their treatment for AML. Please remember that all children are different and only a small number develop long-term problems as a result of their treatment. Parents can talk to their child’s Consultant if they are concerned about them and can visit our beyond treatment section for general information.

Follow-up care
All children will need to be monitored regularly at an outpatients clinic. The consultant will be looking for any signs that the cancer has returned (recurrent cancer) and checking the functions of major organs to make sure that they have not been affected by the cancer treatment.
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The side-effects associated with chemotherapy are tiredness, sickness and diarrhoea, temporary hair loss and infection, all of which can be managed with help from the child’s Consultant or nursing team.  For more information about side-effects please visit our side-effects section.