Childhood Leukemia

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Treating Leukemia in Children TOPICS

Treatment of children with acute myelogenous leukemia

Treatment of most children with acute myelogenous leukemia (AML) is divided into 2 phases of chemotherapy:

  • Induction
  • Consolidation (intensification)

Compared to treatment for ALL, the treatment for AML generally uses higher doses of chemotherapy but for a shorter time. Because of the intensity of treatment and the risk of serious complications, children with AML need to be treated in cancer centers or hospitals that have experience with this disease.

Treatment of the M3 subtype (acute promyelocytic leukemia, or APL) is slightly different, and is described in the next section.

Induction

Treatment for AML uses different combinations of drugs than those used for ALL. The drugs most often used are daunorubicin (daunomycin) and cytarabine (ara-C), which are each given for several days in a row. The schedule of treatment may be repeated in 10 days or 2 weeks, depending on how intense doctors want the treatment to be. A shorter time between treatments causes more severe side effects but may be more effective in killing leukemia cells.

If the doctors think that the leukemia might not respond to just 2 drugs alone, they may add etoposide and/or 6-thioguanine. Children with very high numbers of white blood cells or whose leukemia has certain chromosome abnormalities may fall into this group.

Treatment with these drugs is repeated until the bone marrow shows no more leukemia. This usually occurs after 2 or 3 cycles of treatment.

Preventing relapse in the central nervous system: In most cases, intrathecal chemotherapy (given directly into the cerebrospinal fluid, or CSF) is also given to help prevent leukemia from relapsing in the brain or spinal cord. Radiation therapy to the brain is used less often.

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 (intensification) begins after the induction phase. The purpose is to kill any remaining leukemia cells by using more intensive treatment.

Some children have a brother or sister who would be a good stem cell donor. For these children, a stem cell transplant is often recommended once the leukemia is in remission, especially if the AML has some poorer prognostic factors. Most studies have found this improves the chance for long-term survival over chemotherapy alone, but it is also more likely to cause serious complications. For children with good prognostic factors, some doctors may recommend just giving intensive chemotherapy, and reserving the stem cell transplant in case the AML relapses.

For most children without a good stem cell donor, consolidation consists of the chemotherapy drug cytarabine (ara-C) in high doses. Daunorubicin may also be added. It is usually given for at least several months.

Intrathecal chemotherapy (into the cerebrospinal fluid) is usually given every 1 to 2 months for as long as intensification continues.

Maintenance chemotherapy is not needed for children with AML (other than those with APL, as described in the next section).

An important part of treatment for AML is supportive care (proper nursing care, nutritional support, antibiotics, and blood transfusions). The intensity of treatment needed for AML usually destroys much of the bone marrow (causing severe shortages of blood cells) and can cause other serious complications. Without antibiotic treatment of infections or transfusion support, the current high remission rates would not be possible.

Refractory or recurrent AML

Less than 15% of children have refractory AML (leukemia that does not respond to initial treatment). These leukemias are often very hard to cure, and doctors may recommend a stem cell transplant if it can be done.

Generally, the outlook for a child whose AML relapses (comes back) after treatment is slightly better than if a remission were never achieved, but this depends on how long the initial remission was. In more than half of cases of relapse, a second remission can be achieved with more chemotherapy. The chance of getting a second remission is better if the first remission lasted for at least a year, but long-term second remissions are rare without a stem cell transplant. Many different combinations of standard chemo drugs have been used in these situations, but the results have been mixed.

Most children whose leukemia has relapsed are good candidates for clinical trials testing new treatment regimens. The hope is that some sort of a remission can be attained so that a stem cell transplant can be considered. Some doctors may advise a stem cell transplant even if there is no remission. This can sometimes be successful.


Last Medical Review: 10/24/2013
Last Revised: 02/03/2014