The bone marrow and blood cells
All of the blood cells in the body are produced in the bone marrow: the spongy tissue that is found in the middle of your child's bones. All blood cells start their lives as stem cells. These grow and divide within the bone marrow and mature into:
- Red blood cells that carry oxygen around the body
- White blood cells that help fight infection
- Platelets that help clot the blood to control bleeding and bruising.
When leukaemia occurs, the bone marrow produces a large amount of immature white blood cells. This prevents the normal production of healthy blood cells.
Leukaemia usually affects the production of white blood cells. Acute myeloid leukaemia (AML) is named after the early white myeloid blood cells it affects. There are a number of different types of AML, which are diagnosed by looking at how the leukemia cells look compared to a normal mature myeloid cell. Each type needs a slightly different treatment plan, so it’s best to talk to your specialist for more information.
The other main type of leukaemia in children and young people is acute lymphoblastic leukaemia (ALL). This is named after the early lymphoid white blood cells (which are called ‘lymphoblasts’) that it affects.
AML can occur in anyone of any age. Under the age of two, it affects more boys than girls.
- Anaemia: the number of red blood cells is reduced, leaving your child feeling tired, breathless and constantly run down
- Bruising and bleeding: the number of platelets is reduced, which means your child's blood is not able to clot as well as it did previously
- Infections: your child may get infections more often as there are less healthy blood cells to fight them.
AML is usually suspected from a blood test, which will reveal changes in the numbers of healthy white blood cells. If the blood test suggests that leukaemia is present, a specialist will need to take a sample of your child's bone marrow. This sample will be looked at under a microscope to work out what type of leukaemia they have.
Your child's specialist will also need to do a lumbar puncture to see if their spinal fluid contains any leukaemia cells.
AML is usually treated in two phases.
The first phase, known as ‘induction’, aims to destroy the leukaemia cells with chemotherapy and get your child into remission. When they are in remission, there are no leukaemia cells visible through a microscope in their blood or bone marrow. This phase usually takes four to six weeks and your child may need to spend most of this time at the hospital to reduce the risk of infections.
Your child will then have ‘consolidation treatment’ to stop their leukaemia coming back. This may mean more chemotherapy or a transplant of bone marrow or stem cells from a donor.
If leukaemia cells remain after your child's treatment, or come back, they may need further chemotherapy or a stem cell transplant.
Your child's particular treatment plan will depend on their leukaemia and how it responds to treatment, so it’s best to talk to your specialist about what will be involved.
If your child is having chemotherapy, they may experience tiredness, sickness, diarrhoea and temporary hair loss. They will also be at greater risk of infections. Talk to your specialist or nurses about ways to manage side effects, or see the side effects section of our website.
After your child's treatment is complete they will still need to be seen regularly at an outpatient clinic. At this clinic, your specialist will be looking for any signs that your child's cancer has returned (this is known as a relapse). They will also check that your child's major organs, such as their heart and lungs, are still functioning correctly and haven’t been affected by their cancer treatment.
Once your child's risk of relapse has reduced, ongoing follow up will focus on looking out for potential long-term side effects of treatment. The risk of long-term side effects depends on the type of cancer your child had and the treatment they received.
A personalised surveillance plan is usually created that outlines the specific long-term follow-up and ongoing investigations that your child will require. Most people are at low risk of future health problems but some will have significant ongoing health needs.
Long-term side effects
Undergoing treatment for AML can lead to a range of long-term effects (though these vary from person to person and your child may not experience any at all). These can include fatigue, a lower resistance to infections, infertility, and heart or thyroid problems. Talk to your specialist about the potential long-term side effects of treatment.
- Read about the different treatments for cancer
- Prepare for life on the ward with our practical tips for hospital stays
- Parents tell us it's hard talking to their child about cancer and treatment. Here are our tips and tools on how to make it easier
Updated November 2017, next review due 2019.