Treating Pediatric AML

The goal of treatment for pediatric AML is to destroy the leukemia cells within the bone marrow so that it may function properly again. The overall survival rate for children with AML has reached a higher rate of 65%-70%. Most of the time, the cause of leukemia is unknown. In children, there are some exposures that may increase the risk of disease development:

• Exposure to alcohol or tobacco smoke before birth
• A history of aplastic anemia
• Certain genetic disorders such as Down Syndrome or Neurofibromatosis
• Previous exposure to chemotherapy drugs such as cyclophosphamide
• Previous radiation treatment

Treatment for pediatric AML is divided into 2 main phases of chemotherapy: induction and consolidation. A stem cell transplant and radiation may also be necessary, but chemotherapy is the most common form of therapy. The goal is to keep the leukemia cells from growing, dividing and spreading.

Induction

“The chemo drugs most often used to treat AML are daunorubicin (daunomycin) and cytarabine (ara-C), which are each given for several days in a row. The treatment schedule may be repeated in 10 days or 2 weeks, depending on how intense doctors want the treatment to be. A shorter time between treatments can be more effective in killing leukemia cells, but it can also cause more severe side effects.”

Some children may also have gemtuzumab ozogamicin added to their chemotherapy regimen. Etoposide or 6-thioguanine are also used when two medications may not be effective enough. Treatment with chemotherapy drugs is repeated until the bone marrow shows an absence of leukemia cells. Remission is the goal. 

During treatment, pediatric patients need to be watched carefully because low blood cell counts can increase the risk of infection. Hospitalization during this time may be necessary. The side effects of treatment can vary: fatigue, infection, hair loss, nausea, loss of appetite and diarrhea. 

Consolidation (Intensification)

“About 85% to 90% of children with AML go into remission after induction therapy. This means no signs of leukemia are detected using standard lab tests, but it does not necessarily mean that the leukemia has been cured.” 

Consolidation begins after the initial chemotherapy treatment. This is a more intense therapy that is used to kill any remaining leukemia cells that may be hiding after the induction process. This phase can involve 2 more chemotherapy treatments. Stem cell transplants may also become a necessary option (this treatment will also be used if the leukemia returns).

“Many children with AML are cured. If the leukemia comes back after initial treatment, it usually does so within the first 3 years. Most children with AML grow and develop normally.”