To access information about coping with childhood cancer, click here.
Click here for childhood AML statistics.
Click on the links below for more information about childhood AML:
- Survivorship and Special Healthcare Needs
- Follow-Up Care
- Long-Term and Late Effects of Treatment
- Returning to School
Acute myeloid leukemia (AML) only accounts for about 20 percent of childhood leukemia cases. The overall survival rate has increased for children with AML, but is still much lower than that of childhood acute lymphocytic leukemia (ALL). However, there is a wide range in outcomes for different subtypes of AML, based on genetic factors. Because of the intensity of therapy used to treat AML, children with this disease should have their care coordinated by pediatric hematology-oncology specialists and be treated in cancer centers or hospitals with the appropriate supportive care facilities and services.
As with adults, treatment decisions for children with AML should be based on cytogenetic and molecular factors. The goal of treatment should be to cure the child by killing the leukemia cells while avoiding side effects and late effects of treatment as much as possible.
Chemotherapy. Like AML treatment for adults, the treatment for children usually has two phases, induction therapy and consolidation therapy, which may consist of intensive chemotherapy and/or allogeneic stem cell transplantation. Children are usually treated with an induction therapy similar to that used for adults: cytarabine and an anthracycline, such as daunorubicin; or idarubicin or mitoxantrone in combination with other agents, such as etoposide or thioguanine.
For children who receive intensive chemotherapy, including anthracyclines, ongoing monitoring of cardiac function is critical since these drugs may affect the heart. Periodic examination of kidney function and auditory exams are also recommended.
Stem Cell Transplantation. An allogeneic stem cell transplantation may be used to treat children who have
- High-risk AML, based on cytogenetic and molecular test results
- Primary induction failure
- Relapse after intensive multidrug therapy.
Central Nervous System (CNS) Prophylaxis. Unlike adults with AML, children usually receive central nervous system (CNS) prophylaxis to prevent the spread of leukemia cells to the central nervous system. This is called intrathecal chemotherapy, a treatment in which anticancer drugs are injected directly into the spinal fluid. It is given to kill any AML cells that may be in the brain and spinal cord, even though no cancer cells have been detected in that area. The use of some form of intrathecal chemotherapy is now incorporated into most protocols for the treatment of childhood AML. Intrathecal chemotherapy can be given in combination with other chemotherapy drugs during induction therapy.
Relapsed and Refractory AML. An option in cases of relapsed and refractory AML is gemtuzumab ozogamicin (GO) (MylotargTM), which is FDA-approved for use in patients age 2 years and older with relapsed or refractory, CD33-positive AML. Gemtuzumab ozogamicin is injected slowly into a vein (IV infusion) and is given in cycles consisting of treatment days followed by periods of rest.
For information about the drugs listed on this page, visit Drug Listings.
Clinical Trials. When it comes to finding the right treatment for a child's AML, a clinical trial may be the best treatment option, as clinical trials provide access to new or improved therapies under study and not yet on the market. Treatment in clinical trials is administered in a safe, closely monitored environment. The possibility of participating in a clinical trial should be discussed with the doctor.
Researchers are studying treatment in clinical trials for children and young adults with AML with the aim to
- Improve cure rates
- Decrease side effects and long-term and late effects of chemotherapy
- Make AML therapy safer and reduce chemotherapy side effects and complications, such as infections
- Determine the best treatments for children who have a poor chance of recovering from AML.
Researchers have identified cell targets that appear to be the key to treatment with the new generation of chemotherapy agents. These new targeted agents are being studied in conjunction with chemotherapy to examine their impact upon cure rates and their effect on toxic complications associated with traditional chemotherapy.
Receive one-on-one navigation from an LLS Clinical Trial Specialist who will personally assist you throughout the entire clinical-trial process: Click Here
Subtype Considerations. The following two subtypes of childhood AML are treated differently.
- AML in children with Down syndrome—Children with Down syndrome are at increased risk for developing AML, but in these children, the disease is more sensitive to chemotherapy. As a result, very good cure rates have been achieved with less intensive chemotherapy. Children with Down syndrome who develop AML tend to have a good prognosis, especially if the disease is diagnosed before the age of 4 years.
- Acute promyelocytic leukemia (APL)—This subtype accounts for approximately 7 percent of pediatric AML cases. APL is due to a specific genetic change. Children with APL have a high cure rate. Click here to read about treatment for APL.
After treatment, most children can expect to have full and productive lives. Many survivors return to school, attend college, enter the workforce, marry and become parents.
Childhood cancer survivors have special long-term healthcare needs. Survivorship programs focus on life after cancer and can be very helpful for children with cancer. Several major hospitals around the country offer these programs.
A child should visit his or her pediatrician or doctor at least once a year for a complete physical exam and any additional needed tests. The oncologist should also regularly examine the child.
Regular doctor visits are encouraged to:
- Enable doctors to assess the full effect of therapy
- Detect and treat disease recurrence
- Identify and manage long-term and late effects of treatment
The pediatrician should recommend a schedule for having the child's learning skills assessed. If the child appears to be experiencing learning disabilities, special education methods can help.
Coordination between the child's pediatrician and oncologist is important for the best care possible. Some treatment centers offer comprehensive follow-up care clinics for childhood cancer survivors. To find one near you, visit The Pediatric Oncology Resource Center.
Some side effects of cancer treatment, such as fatigue, can linger for months or years after therapy. Some medical conditions like heart disease and other cancers may not appear until years after treatment ends.
Most childhood survivors of leukemia don't develop significant long-term or late effects of treatment. However, for some patients the effects can range from mild to severe. For children who receive intensive chemotherapy, including anthracyclines, ongoing monitoring of cardiac function is critical since these drugs may affect the heart. Periodic examination of kidney function and auditory exams are also recommended.
Talk to the child's treatment team about possible long-term and late effects. His or her risk for developing long-term or late effects can be influenced by
- Treatment type and duration
- Age at the time of treatment
- Overall health.
Some long-term and late effects become evident with maturation (puberty), growth and the normal aging process. Have the child evaluated with a physical exam yearly or more often as needed. Early intervention and healthy lifestyle practices (not smoking, good nutrition, exercise, regular screenings and follow-up) help.
Long-term and late effects can impact a child's physical, mental and cognitive health in a number of ways.
Physical Effects. Children treated for acute myeloid leukemia may be at increased risk for
- Growth delays
- Thyroid dysfunction
- Hearing loss
- A secondary cancer.
Treatment may affect fertility (the ability to have a child in the future). Talk to the child's treatment team for a referral to a fertility specialist before beginning treatment. Click here to learn more about fertility.
Mental Effects. Most childhood survivors of cancer are psychologically healthy. However, some studies have indicated that a small number of childhood leukemia survivors were more likely than healthy peers to report changes in mood, feelings and behavior, including depression and posttraumatic stress disorder.
Cognitive Effects. Learning disabilities can begin during treatment or appear months or years afterward. Areas that can be affected include
- Spatial relationships
- Problem solving
- Attention span
- Information processing
- Planning and organizing
- Concentration skills
- Fine motor coordination.
Once your child is in remission, he or she will likely be going back to school. This reentry to the classroom can be daunting for a child of any age. Educate family members, friends, school personnel and healthcare providers about your child's possible long-term and late effects of treatment. Talk with teachers about your child's needs before he or she returns to school. Work with your child's teachers and medical providers to develop a program tailored to his or her needs that features baseline testing, special accommodations and long-term planning.
Click here to read about children with cancer returning to school.
- Download or order LLS's free booklets:
- Acute Myeloid Leukemia
- Learning and Living with Cancer: Advocating for Your Child's Educational Needs
- Long Term and Late Effects of Treatment for Childhood Leukemia or Lymphoma Facts
- Choosing a Blood Cancer Specialist or Treatment Center
- Knowing All Your Treatment Options
- Download lists of suggested questions to ask your healthcare providers about treatment options
- About Childhood Blood Cancer
- Long-Term And Late Effects Of Treatment For Childhood Cancer Survivors
- Follow-Up Care for Childhood Cancer Survivors