Treatments for childhood AML

If your child has acute myelogenous leukemia (AML), the healthcare team will create a treatment plan just for your child. It will be based on your child’s health and specific information about the AML. When deciding which treatments to offer for childhood AML, the healthcare team will consider:

• the subtype of AML
• chromosome and gene changes within the leukemia cells
• response to treatment
• whether there are leukemia cells in the brain and spinal cord (called the central nervous system, or CNS)
• your child’s overall health

The following treatments may be offered for childhood AML.

Chemotherapy is the main treatment for childhood AML. Overall treatment for childhood AML usually takes 6 to 8 months.

Induction therapy is the first phase of treatment for childhood AML. It is used to kill all the leukemia cells in the blood and bone marrow to put the leukemia into remission. Induction therapy usually lasts 4 to 8 weeks and involves 1 to 2 cycles of combination chemotherapy. Certain children, such as children with Down syndrome who have FAB M7 AML, do well with low-dose chemotherapy regimens. Your child may have to stay in the hospital during induction chemotherapy.

Chemotherapy drugs that may be used to treat childhood AML include:

• cytarabine (Cytosar)
• fludarabine (Fludara)
• etoposide (Vepesid, VP-16)
• daunorubicin (Cerubidine, daunomycin)
• thioguanine (Lanvis)
• cyclophosphamide (Procytox)
• mitoxantrone
• tretinoin (all-trans retinoic acid, ATRA, Vesanoid)
• arsenic trioxide (Trisenox)
• asparaginase (Kidrolase), pegaspargase (Oncaspar) or asparaginase erwinia (Erwinase)
• clofarabine (Clolar)
• dexamethasone (Decadron, Dexasone)

Consolidation therapy is given after the AML is in remission. It is used to kill any leukemia cells that might still be in the blood or bone marrow to prevent AML from coming back. Consolidation therapy is usually given for about 4 to 6 months. High-dose cytarabine is usually combined with other chemotherapy drugs.

Chemotherapy drugs that may be used with cytarabine include:

• thioguanine
• idarubicin (Idamycin)
• daunorubicin
• etoposide
• asparaginase, pegaspargase or asparaginase erwinia

There are 2 subtypes of childhood AML that are treated differently.

Children with Down syndrome who develop AML and are under 4 years of age are often treated successfully with less intense chemotherapy.

Children with acute promyelocytic leukemia (APL) with t(15;17)(q22;q12) are often treated successfully with tretinoin and arsenic trioxide and may not need chemotherapy.

Central nervous system (CNS) therapy is given to kill any leukemia cells in the CNS and prevent cancer cells from spreading to the CNS. CNS therapy is given using intrathecal chemotherapy, where drugs are given directly into the cerebrospinal fluid (CSF) around the spinal cord. It is usually given at the start of treatment for AML and every 1 to 2 months for as long as treatment lasts. Cytarabine is the drug most commonly used.

Find out more about chemotherapy for childhood leukemia.

A stem cell transplant is used to treat childhood AML. It may be used to treat:

• children with poor prognostic factors
• children with a higher risk of the cancer coming back
• children who have a sibling who is a good match

An allogeneic stem cell transplant is the type of stem cell transplant used with childhood AML.

Find out more about stem cell transplants for childhood leukemia.

Radiation therapy is not commonly used to treat AML. It may be used to treat a chloroma that is causing or has the potential to cause neurological damage, such as vision problems or spinal cord myelopathy.

Find out more about radiation therapy for childhood leukemia.

Some children are very ill when they are diagnosed with AML. Others become ill during treatment. Low blood cell counts can happen because of AML and its treatment and cause serious problems, such as infections, bleeding and even heart failure. Supportive therapy, such as antibiotics, antifungals, blood products, growth factors or other drugs, may be given to treat or prevent some of these problems.

Find out more about supportive therapy for childhood leukemia.

Follow-up after treatment is an important part of cancer care. Your child will need to have regular follow-up visits. These visits allow the healthcare team to monitor your child’s progress and recovery after treatment.

Children with cancer may be treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

To make the decisions that are right for your child, ask the healthcare team questions about treatment.