Acute Myeloid Leukaemia

Leukaemia is a cancer that occurs when abnormal blood stem cells (immature white blood cells) are produced in the bone marrow. Normally white cells develop, repair and reproduce in an orderly fashion. The leukaemia cells do not mature, and therefore are not able to function as immune cells, but they keep on dividing in the bone marrow.

The two most common types of leukaemia found in children are Acute Lymphoblastic Leukaemia (ALL) and Acute Myeloid Leukaemia (AML). Leukaemia accounts for about 35% of all childhood cancers.

Acute cancers get worse very quickly if they are not diagnosed and treated.

All blood cells are made in the bone marrow which contains:

• Red blood cells: They carry oxygen around the body
• White blood cells: They help the body fight infection
• Platelets: They help the blood clot and control bleeding

Acute Myeloid Leukaemia (AML) is also known as Acute Nonlymphocytic Leukaemia, Acute Myeloblastic Leukaemia, Acute Granulocytic Leukaemia, or Acute Myelogenous Leukaemia..

AML occurs when the myeloid stem cells produce too many immature white blood cells called myeloblasts (or myeloid blasts). These are abnormal cells that do not become healthy blood cells and build up in the bone marrow, leaving insufficient space for the healthy white blood cells, red blood cells, and platelets. This can lead to anaemia or easy bleeding, and the leukaemia cells can spread to other parts of the body such as the gums and the central nervous system (brain and spinal cord), and the skin.

Causes of Acute Myeloid Leukaemia

Although a lot of research has been and is still being done as to the causes of Acute Myeloid Leukaemia, the exact cause, as with other leukaemias, is not known. There are, however, several risk factors that have been associated with AML, such as the Myelodysplastic syndromes (MDS) or aplastic anaemia (when associated with certain genetic syndromes like Fanconi’s anaemia).

Children with genetic disorders such as Li-Fraumeni syndrome and Down’s syndrome are known to have a higher risk of developing AML. AML may occur after treatment with certain anticancer drugs and/or radiation therapy.

Signs and Symptoms

Some of the typical signs and symptoms of AML are:

• Lethargy, weakness, pallor, dizziness, night sweats, or shortness of breath
• Flat, pinpoint spots under the skin called petechiae, caused by a low platelet count.  
• Fever with or without an infection
• Aches and pains in the limbs
• Swollen lymph glands
• Painless lumps called leukaemia cutis, which may be blue or purple in the neck, stomach, groin, or underarm
• Painless lumps called chloromas that may be a blue-green

Many of the above symptoms could also be a sign of a different medical condition. Children will not normally complain of feeling sick, very tired or weak, so if they do, please consult your child’s doctor immediately.

Tests and Diagnosis

AML can be diagnosed or staged using the following tests and procedures:

• Physical Exam and History: The doctor will perform a physical examination, checking your child’s general health as well as checking for anything unusual or any lumps. The doctor will also request complete medical history including health habits, past illnesses and eating habits.
• A Complete Blood Count (CBC): This procedure is crucial in the diagnosis of leukaemia and will involve blood being drawn and sent for various tests to check the number of red blood cells, white blood cells, and platelets, and the amount of haemoglobin (the protein that carries oxygen) in the red blood cells
• A Bone Marrow Aspiration and Biopsy: A sample of the bone marrow is required to confirm the diagnosis. This is done by inserting a hollow needle into the hipbone or breastbone and withdrawing a sample. These samples, containing blood, bone, and bone marrow are scrutinised under a microscope in a laboratory test.

Other tests that may be done include x-rays, a complete blood count, blood chemistry studies, Cytogenetic analysis, or a lumbar puncture amongst others.

Treatment Options

Treatment options consist of:

Chemotherapy, the use of a combination of anti-cancer drugs to destroy cells is the correct treatment for AML in children.

1. Induction: Intensive treatment of a combination of chemotherapy drugs. A bone marrow test is done at the end of this phase to determine whether the child still has leukaemia. If there is none, the child is in remission.
2. Post-remission treatment is often given when there is no sign of leukaemia in the blood or bone marrow, to destroy any lurking leukaemia cells and prevent the AML from returning.
3. A Bone marrow transplant is indicated in children with AML.

Some of the treatment options may result in after-effects such as nausea, vomiting, irritation or soreness of the skin from radiation, hair loss, risk of infection, fatigue, bruising and bleeding or diarrhoea. The doctor should explain all of this to you, but if they do not, please ask them about side effects.

Awareness Ribbon Colour

The awareness ribbon colour for Acute Myeloid Leukaemia (AML) is Orange.

This article was researched and written on behalf of Little Fighters Cancer Trust by Billi du Preez of Red Feather Scribe.

Academic Editing by Dr Marc Hendricks MBChB (UCT), DIP PEC (SA), DCH (SA), FCPaeds (SA), CMO Paeds (SA) Senior Specialist, Paediatric Oncologist Red Cross War Memorial Children’s Hospital

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