Which children are candidates for transplant and which are not?

When would a child be or not be a candidate for transplant? So a child who is chosen for transplant is a child who has either very aggressive disease or disease that is expected to be very aggressive. What we're trying to do with the first few rounds of chemotherapy is to get that child into what we call remission, where we cannot detect any more leukemia cells. What we know is that some types of leukemia will have a harder time remaining in remission. So for example, you get the child into remission and then the leukemia comes back. If the child has a type of AML that we know to be very high risk of that, then they will receive a transplant as soon as they are in remission. For some children, we do not expect them to have a relapse. We expect that once they get into remission that they will stay in remission. But unfortunately, if they do relapse, then that child will be a candidate for transplant. Is there maintenance therapy for children who don't go through transplant? For children with leukemia, there's quite a big difference between the way we treat ALL and AML. For children who have ALL, they get several months of very intensive therapy followed by a very long period of what's called maintenance. That maintenance period can last two or three years and it's basically consisting of low dose chronic chemotherapy. That's not true in AML. We realized that the children who have AML do not benefit at all from maintenance therapy and so there's no need to do it. That means that chemotherapy and treatment for AML is very intense but much shorter, generally along the lines of about six months of several intensive cycles of chemotherapy but no maintenance.