Leukemia is a type of cancer that affects the body's white blood cells (WBCs).
Normally, WBCs help fight infection and protect the body against disease. But in leukemia, WBCs turn cancerous and multiply when they shouldn't, resulting in too many abnormal WBCs, which then interfere with the body's ability to work as it should.
In acute myeloid leukemia (AML), too many immature white blood cells (called myeloid blasts) are made. These leukemia cells are abnormal and cannot mature into normal white blood cells. Of kids who have leukemia, 20% have AML.
Thanks to advances in therapy and clinical trials, the outlook for kids with AML has improved. With treatment, most are cured.
The cause of AML is unknown, though doctors know that certain medical conditions can increase a child's risk of getting it. However, just because a child has a risk factor does not mean that he or she will get AML.
Risks include inherited genetic problems such as Down syndrome, neurofibromatosis type 1, Fanconi anemia, Noonan syndrome, and other inherited bone marrow failure syndromes (IBMFS). Also, non-inherited conditions such as preleukemia (also called myelodysplastic syndrome, or MDS) and aplastic anemia can increase the risk of AML.
A child with an identical twin who was diagnosed with leukemia before age 6 has a 20% to 25% chance of developing AML. Fraternal twins and other siblings of kids with leukemia have two to four times the average risk of developing it, too.
Certain environmental factors can predispose a child to leukemia. For example, exposure to radiation (such as X-rays) before birth may trigger the disease in a developing fetus.
Signs and Symptoms
AML is called "acute" because it tends to worsen quickly if it's not treated. Chronic blood cancers, like chronic myelogenous leukemia (CML), tend to progress more slowly. However, the symptoms of all types of leukemia are generally the same and include:
- fatigue (tiredness) and weakness
- swollen lymph nodes
- infections (like bronchitis or tonsillitis) that keep coming back
- night sweats
- easy bruising or petechiae (tiny red spots on the skin caused by easy bleeding)
- bone and joint pain
- abdominal pain (caused by abnormal blood cells building up in organs like the kidneys, liver, and spleen)
Sometimes a child might have painless lumps that can be felt in the lymph nodes of the neck, underarm, or groin area. These lumps of leukemia cells (called chloromas) can develop anywhere in the body.
If a doctor suspects leukemia, a child may undergo tests that include:
- Blood tests. Tests such as a complete blood count, liver and kidney function panels, and blood chemistries can give important information about the number of normal blood cells in the body and how well the organs are working. The blood cells will also be examined under a microscope to check for abnormal shapes or sizes, and determine which subtype of AML a child has.
- Bone marrow aspiration and biopsy. In this procedure, the doctor inserts a needle into a large bone, usually the hip, and removes a small amount of bone marrow to examine it for abnormal cells.
- Imaging studies. These may include an X-ray, CT scan, MRI, or ultrasound to check for an enlarged spleen or liver, and also to rule out any other possible causes of a child's symptoms.
- Lumbar puncture. Also called a spinal tap, this procedure uses a hollow needle to remove a small amount of cerebrospinal fluid (CSF, the fluid surrounding the brain and spinal cord) for examination in a lab.
- Flow cytometry tests. Using markers on leukemia cells collected from the blood, bone marrow, and/or CSF, doctors can determine the type of leukemia a child has. This is important because treatments vary among different types of leukemia.
- Chromosomal tests. By analyzing DNA from blood or bone marrow, doctors can check for the specific genetic changes that identify the various subtypes of AML. This is important because treatment may vary depending on which AML subtype a child has.
- Tissue typing or HLA (human leukocyte antigen) typing. If a child needs a stem cell transplant (also called a bone marrow transplant), this test helps doctors find a suitable stem cell donor. It works by comparing the proteins on the surface of a child's blood cells with the proteins on a potential donor's cells. The more "HLA markers" a child and donor share, the greater the chance that a transplant will be successful.
Because it can progress so quickly, there is no staging system for AML. Doctors generally characterize the disease as newly diagnosed or in remission.
Treatment is divided into two phases. The goal of the first phase, called induction, is to kill as many cancer cells as possible and achieve remission (a state where there is no evidence of disease in the body). The second phase — called post-remission, consolidation, or continuation therapy — is designed to eliminate any undetectable leukemia cells to prevent the leukemia from coming back.
Phases I and II of treatment may include the following therapies alone or in combination:
- Chemotherapy. This is the use of special drugs to kill the cancer cells. Often, several drugs are combined to attack the cancer cells in different ways.
- Chemotherapy through lumbar puncture. This procedure, known as intrathecal (IT) chemotherapy, delivers the drugs directly to the cerebrospinal fluid, where cancerous cells can collect.
- All-trans retinoic acid (ATRA). This vitamin A treatment is sometimes given along with chemotherapy to kids with acute promyelocytic leukemia (APL), a subtype of AML.
- Arsenic trioxide. This substance (an inorganic compound) is also used to treat kids with APL.
- Stem cell transplant (also called bone marrow transplant). This procedure involves destroying cancer cells and normal bone marrow and immune system cells with high-dose chemotherapy and then reintroducing healthy donor stem cells into the body. These new stem cells can rebuild a healthy blood supply and immune system.
- Clinical trials. These are research studies that offer promising new treatments that are not yet available to the general public. Doctors will decide if a child is a good candidate for a clinical trial.
Being told that a child has cancer can be terrifying, and the stress of cancer treatment can feel overwhelming for any family.
Although you might feel like it at times, you're not alone. To find support that might help you or your child, talk to your doctor or a hospital social worker. Many resources are available to help you get through this difficult time.
Reviewed by: Emi H. Caywood, MD
Date reviewed: June 2015
|CureSearch for Children's Cancer CureSearch for Children's Cancer supports and sponsors research and treatment for childhood cancers.|
|American Cancer Society The American Cancer Society is the nationwide community-based voluntary health organization dedicated to preventing cancer, saving lives and diminishing suffering from cancer through research, education, advocacy, and service. Call:(800) ACS-2345|
|National Marrow Donor Program (NMDP) The NMDP is a nonprofit organization that facilitates unrelated marrow and blood stem cell transplants for people with life-threatening diseases who do not have matching donors in their families.|
|Alex's Lemonade Stand Foundation for Childhood Cancer A unique foundation that evolved from a young cancer patient's front-yard lemonade stand to a nationwide fundraising movement to find a cure for pediatric cancer.|
|National Cancer Institute (NCI) NCI provides detailed information about cancer research, various kinds of cancer, and living with cancer. Call: (800) 4-CANCER|
|Leukemia & Lymphoma Society The Leukemia & Lymphoma Society is dedicated to funding blood-cancer research, education, and patient services. The Society's mission is to cure leukemia, lymphoma, Hodgkin's disease, and myeloma, and to improve the quality of life of patients and their families. Call: (914) 949-5213|
|Neutropenia Certain cancers, or cancer treatment, can weaken the immune system, requiring a child to stay home to avoid exposure to germs. Here are ways to help your child make the best of it.|
|Chronic Myelogenous Leukemia (CML) While this type of blood cancer is more common in adults, it affects children, too. Thanks to advances in therapy, most kids with CML can be cured.|
|Acute Lymphoblastic Leukemia (ALL) ALL is the most common type of leukemia, affecting nearly 75% of kids who have this cancer of the blood cells. With treatment, most recover.|
|Chemotherapy Chemotherapy medications are used to treat cancer throughout the body by killing actively dividing cells. Learn more about chemo.|
|Leukemia Leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). With the proper treatment, the outlook for kids who are diagnosed with leukemia is quite good.|
|Aspiration and Biopsy: Bone Marrow A bone marrow aspiration and biopsy are performed to examine bone marrow, the spongy liquid part of the bone where blood cells are made.|
|Stem Cell Transplants Stem cells help rebuild a weakened immune system. Stem cell transplants are effective treatments for a wide range of diseases, including cancer.|
|Caring for a Seriously Ill Child Taking care of a chronically ill child is one of the most draining and difficult tasks a parent can face. But support groups, social workers, and family friends often can help.|
|Juvenile Myelomonocytic Leukemia (JMML) Learn about this type of blood cancer that usually affects kids under 2 years old.|
|Childhood Cancer Different kinds of childhood cancer have different signs, symptoms, treatments, and outcomes. But today, over 80% of all children with cancer live 5 years or more.|
|Cancer Center From treatments and prevention to coping with the emotional aspects of cancer, the Cancer Center provides comprehensive information that parents need.|
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
© 1995-2016 KidsHealth® All rights reserved.
Images provided by iStock, Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart.com