Treatment of children with acute myeloid leukemia

Treatment for most children with acute myeloid leukemia (AML) has 2 phases:

• Induction
• Consolidation (intensification)

Compared to treatment for ALL, the treatment for AML generally uses higher doses of chemotherapy (chemo) but for a shorter time. Because treatment is very intense and there is a risk of serious complications, children with AML should be treated in cancer centers or hospitals that have a lot of experience with this disease.

Induction

The combinations of drugs used to treat AML are different from those used for ALL. Treatment is given in cycles that usually last several days. The schedule of treatment may be repeated in 10 days or 2 weeks, depending on how intense the doctor wants the treatment to be. Treatment is repeated until the bone marrow shows no more leukemia. This usually happens after 2 or 3 treatments. Often chemo is put into the cerebrospinal fluid (CSF), too. Usually radiation treatment to the brain is not needed.

Consolidation (intensification)

This phase begins after a remission when no more leukemia cells are seen in the bone marrow. 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. Most studies have found this improves the chance for long-term survival over chemo alone. But it is also more likely to cause serious complications. For children with good prognostic factors, some doctors recommend just giving high-dose chemo and holding off on the stem cell transplant in case the AML relapses.

For most children, high-dose chemo is given for at least several months. Chemo into the CSF is usually given at the start and every 1 to 2 months for as long as this phase lasts.

Most children with AML (except those with acute promyelocytic leukemia) do not need maintenance chemo.

An important aspect of treatment for AML is supportive care (nursing care, nutrition, antibiotics, blood transfusions, etc.). With this care, a high rate of remission at the end of induction can be achieved.

Treatment of 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. The doctor may recommend a stem cell transplant if it can be done.

As a rule, the outlook for a child whose AML comes back after treatment is slightly better than if a remission were never achieved. But this depends on how long the first remission lasted. More than half of these children will go into a second remission with more chemo. The chance of a second remission is better if the first one lasted for at least a year, but long-term second remissions are rare without a stem cell transplant.

Most children whose leukemia has relapsed will be offered a clinical trial in the hope that if a remission is brought about, a stem cell transplant can then be done. Sometimes the doctor may suggest a stem cell transplant even without a remission.