Acute Myeloid Leukaemia
Leukaemia is a cancer that occurs when abnormal blood stem cells (immature white blood cells) are produced in the bone marrow. Normally white cells develop, repair and reproduce in an orderly fashion. The leukaemia cells do not mature, and therefore are not able to function as immune cells, but they keep on dividing in the bone marrow.
The two most common types of leukaemia found in children are Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML). Leukaemia accounts for about 35% of all childhood cancers. Acute cancers get worse very quickly if they are not diagnosed and treated.
All blood cells are made in the bone marrow which contains:
- Red blood cells: They carry oxygen around the body
- White blood cells: They help the body fight infection
- Platelets: They help the blood clot and control bleeding
Acute Myeloid Leukaemia (AML) is also known as Acute Nonlymphocytic Leukaemia, Acute Myeloblastic Leukaemia, Acute Granulocytic Leukaemia, or Acute Myelogenous Leukaemia.
AML occurs when the myeloid stem cells produce too many immature white blood cells called myeloblasts (or myeloid blasts). These are abnormal cells that do not become healthy blood cells and build up in the bone marrow, leaving insufficient space for the healthy white blood cells, red blood cells, and platelets. This can lead to anaemia or easy bleeding, and the leukaemia cells can spread to other parts of the body such as the gums and the central nervous system (brain and spinal cord), and the skin.
Causes of Acute Myeloid Leukaemia
Although a lot of research has been and is still being done as to the causes of Acute Myeloid Leukaemia, the exact cause, as with other leukaemias, is not known. There are, however, several risk factors that have been associated with AML, such as the Myelodysplastic syndromes (MDS) or Aplastic anaemia.
Children with genetic disorders such as Li-Fraumeni syndrome and Down’s syndrome are known to have a higher risk of developing AML. AML may occur after treatment with certain anticancer drugs and/or radiation therapy.
Signs and Symptoms
Some of the typical signs and symptoms of AML are:
- Lethargy, weakness, paleness, dizziness, night sweats, or shortness of breath
- flat, pinpoint spots under the skin called petechiae, caused by bleeding
- Fever with or without an infection
- Aches and pains in the limbs
- Swollen lymph glands
- Painless lumps called leukaemia cutis, which may be blue or purple in the neck, stomach, groin, or underarm
- Painless lumps called chloromas that may be a blue-green
Tests and Diagnosis
AML can be diagnosed or staged using the following tests and procedures:
- Physical Exam and History: A physical examination to check your child’s general health and check for anything unusual or signs of cancer. A complete medical history will be taken.
- Peripheral Blood Smear: A blood sample is checked for the presence of blast cells, the number of platelets, the number and types of white blood cells.
- A Biopsy: Doctors always perform a bone marrow biopsy whether a lymph node biopsy is required in addition or not.
Other tests that may be done include x-rays, a complete blood count, blood chemistry studies, a bone scan, Cytogenetic analysis, or a lumbar puncture amongst others.
Treatment options consist of:
Chemotherapy, the use of a combination of anti-cancer drugs to destroy or shrink cancer cells is the preferred treatment for AML in children, and is done in phases:
- Induction: Intensive treatment of two courses or cycles of a combination of chemotherapy drugs. A bone marrow test is done at the end of this phase to determine whether the child still has leukaemia. If there is none, the child is in remission.
- Post-remission treatment is often given when there is no sign of leukaemia in the blood or bone marrow, to destroy any lurking leukaemia cells and prevent the AML from returning
- A Bone marrow transplant is indicated in children with AML.
Some of the treatment options may result in after-effects such as nausea, vomiting, irritation or soreness of the skin from radiation, hair loss, risk of infection, fatigue, bruising and bleeding or diarrhoea. The doctor should explain all of this to you, but if they do not, please ask them about side effects.
Awareness Ribbon Colour
The awareness ribbon colour for Acute Myeloid Leukaemia (AML) is Orange
Academic Editing by Dr Marc Hendricks MBChB (UCT), DIP PEC (SA), DCH (SA), FCPaeds (SA), CMO Paeds (SA) Senior Specialist, Paediatric Oncologist Red Cross War Memorial Children’s Hospital
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