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General Information About Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies
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Childhood acute myeloid leukemia (AML) is a type of cancer in which
the bone marrow makes a large number of abnormal blood cells.
Childhood acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, or acute nonlymphocytic leukemia.
Other diseases that affect the blood and bone marrow are myelodysplastic syndromes and juvenile myelomonocytic leukemia (JMML). Normally,
the bone marrow produces stem cells (immature cells) that develop into mature blood cells. There are three types of mature blood cells: In AML, the stem cells usually develop into a type of white blood cell called myeloblasts (or myeloid blasts). The myeloblasts, or leukemia cells, in AML are abnormal and do not mature into healthy white blood cells. Leukemia cells are unable to do their usual work and can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur. The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums.
This summary is about childhood AML, myelodysplastic syndromes, and JMML.
Refer to the following PDQ summaries for more information about other types of leukemia and diseases of the blood and bone marrow:
There are different subtypes of childhood AML.
The subtypes of AML are based on the type of blood cell that is affected, how mature (developed) the cancer cells are at the time of diagnosis, and how different they are from normal cells. The treatment for most subtypes of AML is similar. One subtype of AML, acute promyelocytic leukemia (APL), is treated differently from other types of AML.
Myelodysplastic syndromes are caused by changes in the blood-forming cells of the bone marrow. They are not a type of leukemia.
In myelodysplastic syndromes, the bone marrow makes too few red blood cells, white blood cells, and platelets. These blood cells may not mature and enter the blood. The treatment for myelodysplastic syndromes depends on how much lower than normal the number of red blood cells, white blood cells, or platelets is. Myelodysplastic syndromes may progress to AML.
Juvenile myelomonocytic leukemia (JMML) is a type of cancer in which the bone marrow makes too many white blood cells. Juvenile myelomonocytic leukemia (JMML) is a rare childhood cancer that occurs more often in children younger than 2 years. In JMML, the bone marrow makes too many white blood cells. The white blood cells are unable to do their usual work and can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets.
Exposure to radiation and a history of myelodysplastic syndrome or aplastic anemia may affect the risk of developing childhood AML.
Possible risk factors for AML include the following:
Possible risk factors for myelodysplastic syndromes include the following: - Past treatment with chemotherapy or radiation therapy.
- Being exposed to ionizing radiation or chemicals such as benzene.
- Having certain genetic disorders, such as Down syndrome or Fanconi's anemia.
One possible risk factor for JMML is having certain genetic disorders such as neurofibromatosis type 1 or Noonan's syndrome.
Possible signs of childhood AML, myelodysplastic syndromes, or JMML include
fever, feeling tired, and easy bleeding or bruising.
These and other symptoms may be caused by childhood AML, myelodysplastic syndromes, JMML, or other
conditions. A doctor should be consulted if any of the following problems
occur:
- Fever with or without an infection.
- Shortness of breath.
- Weakness or feeling tired.
- Easy bruising or bleeding.
- Petechiae (flat, pinpoint spots under the skin caused by bleeding).
- Pain in the bones or joints.
- Pain or feeling of fullness below the ribs.
- Painless lumps in the neck, underarm, stomach, groin, or other parts of the body. When seen in childhood AML, these lumps, called leukemia cutis, may be blue or purple.
- Painless lumps that are sometimes around the eyes. These lumps, called chloromas, are sometimes seen in childhood AML and may be blue-green.
Tests that examine the blood and bone marrow are used to detect
(find) and diagnose childhood AML, myelodysplastic syndromes, or JMML.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Complete blood
count (CBC): A procedure in which a sample of blood is drawn and
checked for the following:
- The number of red blood cells, white blood cells, and
platelets.
- The amount of hemoglobin (the protein that carries oxygen) in
the red blood cells.
- The portion of the sample made up of red blood
cells.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
- Peripheral blood smear: A procedure in which a sample of blood is checked for blast cells, number and kinds of white blood cells, number of platelets, and changes in the shape of the blood cells.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. Biopsies that may be done for childhood AML include the following:
- Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone marrow biopsy and the bone marrow aspiration samples under a microscope to look for abnormal cells.
- Tumor biopsy: A biopsy of a chloroma may be done.
- Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
- Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are changes in the structure or number of chromosomes in the cells.
- Immunophenotyping: A process used to identify cells, based on the types of antigens or markers on the surface of the cell, that may include special staining of the blood and bone marrow cells. This process is used to diagnose the subtype of AML by comparing the cancer cells to normal cells of the immune system.
- Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options for AML depend on the following: - Age, general health, and number of white blood cells in the blood at
diagnosis.
- Whether the AML was caused by previous anticancer treatment.
- The subtype of AML.
- Whether the disease has spread to the
central nervous system (brain and spinal cord) or to other parts of the body.
- Whether the child has Down syndrome. Most children with AML and Down syndrome can be cured of their leukemia.
- How well the leukemia responds to initial treatment.
- Whether the AML is untreated or has recurred (come back) after being treated.
The prognosis (chance of recovery) and treatment options for myelodysplastic syndromes depend on the following: - Whether the myelodysplastic syndrome was caused by previous cancer treatment.
- How low the red blood cells, white blood cells, or platelets are.
- Whether the myelodysplastic syndrome is untreated or has recurred after treatment.
The prognosis (chance of recovery) and treatment options for JMML depend on the following: - The age of the child.
- How many red blood cells, white blood cells, or platelets are in the blood.
- Whether the JMML is untreated or has recurred after treatment.
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