Leukemia, a type of cancer that typically forms in white blood cells, is the most common childhood cancer. It affects 1 out of 3 children and teens diagnosed with cancer. Of these children, 1 in 4 have acute myeloid leukemia (AML). This blood cancer starts in bone marrow, the spongy tissue inside bones.

What is acute myeloid leukemia?

AML is a blood cancer that forms in myeloid cells. These cells typically produce healthy white blood cells, red blood cells, and platelets. Your child’s immune system needs white blood cells to fight infections and protect against diseases. Red blood cells carry oxygen throughout the body, while platelets aid blood clotting.

When a child has AML, white blood cells don’t fully develop or mature (experts aren’t sure why). As a result, your child’s bone marrow creates large numbers of immature white blood cells called myeloid blasts. These cancerous cells quickly crowd out healthy cells, making your child sick.

As the name indicates, AML is an acute disease, meaning it comes on suddenly and severely. Because AML can quickly spread to other parts of the body, immediate medical treatment is important.

Who is at risk for acute myeloid leukemia?

AML affects all ages, races, and genders. It’s much more common in adults than in children. Still, approximately 730 children and teens receive an AML diagnosis every year.

Most of the time, there’s no explanation for why a child gets AML. Sometimes, a child has a medical condition that increases cancer risk, such as:

• Bloom syndrome

• bone marrow failure syndromes

• Diamond-Blackfan anemia

• Down syndrome

• Kostmann syndrome

• Fanconi anemia

• neurofibromatosis (NF)

• Noonan syndrome

• trisomy 8

AML often develops as a secondary cancer in children who have previously received chemotherapy or radiation therapy for a different type of cancer. The environment may also be a factor. Early radiation exposure — often through X-rays — before a baby is born or during a child’s early years can increase a child’s cancer risk.

Is acute myeloid leukemia inherited?

Some children inherit gene mutations, or changes, from a parent that increase the risk of certain types of cancer (such as the mutated BRCA gene linked to breast cancer). While there doesn’t appear to be a genetic link to AML, a child may inherit a genetic disorder like neurofibromatosis that increases AML risk.

AML can affect children in the same family. An identical twin has a 1 in 4 chance of developing AML if their twin sibling developed the disease before age six. AML risk is 2 to 4 times greater among fraternal twins and people who have a sibling with the disease.

What are the symptoms of acute myeloid leukemia?

A child who has AML or another type of leukemia may experience these symptoms:

• bone or joint pain

• easy bruising or bleeding

• enlarged lymph nodes

• fatigue

• fever

• loss of appetite and weight loss

• night sweats

• painless blue-green lumps around the eyes (called chloromas)

• painless blue or purple lumps in the neck, armpit, belly, or groin (called leukemia cutis)

• shortness of breath

• skin rash (petechiae)

From the community: “In my case it happened slowly over summer break when we were entering the 9th grade. I was at boyscout camp and my I felt very weak and got winded easily when swimming, football, hiking into a gulch all things i could normally do no problem I had trouble doing. The real shocker was when I couldn't finish my shotgun badge because I was too sick to continue shooting the clay pigeons and that takes almost no effort for me. My parents told me that my skin was yellow, this was because I was Anemic. When I got home from camp we went to see my doctor and he gave me some anti-biotics because he thought I just had a cold. I then went on another boy scout trip to the island of Lanai for a few days and when I returned I felt even worst. Thinking I was sick from a cold I continued the anti-biotics… The next day was the first day of school. I didnt want to miss it because I wanted to see my friends and know where all of my classes were. But within hours I fainted and a security guard brought me to the health room, my dad came to pick me up because I was wasted. I went across the street where my clinic is located and had a blood test taken. Not even two hours later they called us up and told us to get a few days of clothes together and come down to the clinic where they put an I.V in me and had me flown by air ambulance to a different island with better hospitals. My hemoglobin was at 4.0 and they infused me with blood. They also did a bone marrow biopsy to see why I was anemic. They sent me back afterwards and told me that I could go back to school. I went back for about a month receiving blood transfusions here and there, then they called me back to the island of Oahu for another bonemarrow biopsy and this time they found blasts ( cancer cells). I was started on chemotherapy immediately. well thats pretty much how they found it.” – Inspire member

How is acute myeloid leukemia diagnosed?

Cancer specialists use the same tests to diagnose AML in children and adults. These diagnostic tests include:

• complete blood count (CBC) to determine the number of platelets and red and white blood cells

• peripheral blood smear to examine blood samples under a microscope and look for changes in the number of blood cells and their appearance 

• bone marrow tests to identify myeloid blasts (abnormal cells) in bone marrow and definitively diagnose or rule out AML

• genetic tests to identify mutations, or changes, in genes that may cause AML

• imaging scans, such as X-rays and CT scans, to see if cancer has spread to organs or the spine

• spinal tap (lumbar puncture) to check for AML cells in fluid surrounding the brain and spine (if there’s concern that the cancer has spread)

How is acute myeloid leukemia treated?

Treatments for AML can put the disease in remission. When a child is in remission, it means tests show no sign of disease, and your child has no symptoms. Chemotherapy to kill cancer cells is the first treatment step for children (and adults) with AML.

This first phase of treatment, called remission induction therapy, may include:

• Intrathecal chemotherapy: Children (but not adults) receive a chemotherapy injection directly into the spinal fluid as a prophylactic (preventive) measure. Known as intrathecal chemotherapy, this step may keep cancer cells from spreading to the spine, brain, and other parts of the central nervous system. Intrathecal chemotherapy is often given with other chemotherapy drugs as part of induction therapy.

• Monoclonal antibody therapies: These laboratory-made proteins attach to cancer cells to stop them from multiplying and growing. In June 2020, the U.S. Food and Drug Administration (FDA) extended approval for the drug Mylotarg® (gemtuzumab ozogamicin) for the treatment of certain types of AML in children ages 1 month and older. It was originally approved in 2017 for adults and children older than 2 years with AML that doesn’t respond to treatment (refractory) or is recurring (relapsed).

Post-remission therapy (the second phase) keeps inactive cancer cells from becoming active, preventing cancer relapse or recurrence. Treatments include:

• Immunotherapy: Natural killer (NK) cells taken from a healthy parent’s blood are infused into a child’s blood, where they circulate and target cancer cells.

• Radiation therapy: High-energy X-rays or other radiation sources damage and destroy cancer cells to stop them from multiplying. Radiation therapy is rarely used to treat AML in children.

• Trials: New therapies are still in development. Many show promise in treating AML. Your doctor can discuss appropriate opportunities for your child with you.

What are typical AML treatment outcomes for children with acute myeloid leukemia?

Children with AML usually respond more favorably to cancer treatments than adults. An estimated 2 out of 3 children and young adults below the age of 20 have a 5-year survival rate after an AML diagnosis.

Approximately 15% of children have refractory AML, or cancer that doesn’t respond to treatment. This prognosis is more difficult to treat than when children go into remission (no sign of disease) and later experience a cancer recurrence.

While most children with AML go on to lead full, productive lives, survivors of childhood cancer may have long-term healthcare needs related to the disease and its treatments. Many cancer centers have survivorship programs that support pediatric cancer survivors and their families.

From the community: “I have had AML's since I was about 6 years old, (32 of them, in both kidney's) I am 26 years old today have so far not suffered from them in any way (besides missing school for bi yearly check ups). My doctor keeps telling me to be on top of them, to be careful and mindful (especially if I plan on getting pregnant one day), so far they have asymptomatic. Hope it helps, may G-d bless you and give you the strength it takes to get through this ordeal. Sending well wishes your way!” – Inspire member

From the community: “Sup, I was diagnosed with AML which is a type of leukemia when I was 13 years old. I was anemic and fainted on the first day of high school. I got put into an air ambulance and flown to a hospital… They did a bone marrow biopsy on me and found blasts. I was immediately started on chemotherapy and they took bone marrow biopsy but the result was that the cancer remained. I was put into the "high risk" category and that meant that I would need a bone marrow transplant. After three months of waiting for my cells to recover they did another biopsy and the result was that the cancer still remained. I… got started on chemotherapy…. After the chemotherapy was all done I was started on the radiation treatments. I would get up at 6AM and be ready to go to another hospital by ambulance by 7AM. The radiation treatments were horrible, i felt like crap even though it was twice a day for 7 days and only a few minutes at a time I still felt like crap during/after the treatments. I was given 1 day of rest after I finished my radiation and chemotherapy then I was given my... transplant on April 15 ( tax day )." – Inspire member

Sources

• Leukemia in Children. American Cancer Society. June 2020.

• Risk Factors for Acute Myeloid Leukemia (AML). American Cancer Society. August 2018.

• Treatment of Children With Acute Myeloid Leukemia (AML). American Cancer Society. June 2020.

• What Causes Acute Myeloid Leukemia (AML)? American Cancer Society. August 2018.

• Leukemia – Acute Myeloid – AML – Childhood: Statistics. American Society of Clinical Oncology. January 2020.

• FDA Approves Mylotarg for Children with Acute Myeloid Leukemia. CancerHealth. June 2020.

• About Acute Myeloid Leukemia (AML) in Children. CureSearch for Children’s Cancer.

• Acute Myeloid Leukemia (AML). Johns Hopkins All Children’s Hospital. 

• Childhood AML. Leukemia and Lymphoma Society. 

• Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®) — Patient Version. National Cancer Institute. October 2019.

• Acute Myeloid Leukemia (AML). St. Jude Children’s Research Hospital. 

• FDA Approves Mylotarg for Treatment of Acute Myeloid Leukemia. U.S. Food and Drug Administration. September 2017.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.