Acute Myeloid Leukemia (AML) in Children

Acute Myeloid Leukemia (AML) in Children Leukemia is a type of cancer that affects the blood, specifically the white blood cells, and begins in the bone marrow. Leukemias are classified based on: How fast they progress (acute or chronic) Which blood cells they affect (myeloid or lymphoid) Acute myeloid leukemia (AML) is a fast-growing leukemia that affects myeloid white blood cells. Although AML is more common in adults, it can also affect children. Approximately 17% of all AML cases occur in childhood. In healthy children, the bone marrow produces immature cells called stem cells, which gradually mature into healthy blood cells. In AML, a genetic mutation disrupts this process, causing immature myeloid cells to grow uncontrollably. These abnormal cells crowd out healthy blood cells, leading to serious complications. Childhood AML can occur at any age but is most commonly diagnosed in: Children under 2 years old Teenagers Signs and Symptoms of AML in Children Children with AML may show some or many of the following symptoms. The presence of symptoms varies from child to child. Common symptoms include: High or persistent fever, sometimes following an infection Fatigue, weakness, and shortness of breath Pale skin due to anemia (low red blood cell count) Easy bruising or bleeding Skin rash Unexplained weight loss and loss of appetite Bone or joint pain, often below the ribs Frequent infections Other possible signs: Blue or purple painless lumps in the neck, armpits, groin, or abdomen Blue-green painless lumps around the eyes Persistent headaches or migraines These symptoms are not exclusive to AML, but persistent or worsening signs should always be evaluated by a doctor. Causes and Risk Factors AML is caused by genetic mutations in bone marrow cells. In most children, AML develops sporadically, without a known cause. However, certain factors increase the risk. Known risk factors include: Previous cancer treatment, especially high-dose chemotherapy or radiation therapy Exposure to tobacco or alcohol before birth Certain genetic and inherited conditions, including: Down syndrome Fanconi anemia Aplastic anemia Myelodysplastic syndrome (MDS) Li-Fraumeni syndrome Neurofibromatosis type 1 Noonan syndrome Shwachman-Diamond syndrome Ataxia-telangiectasia Diamond-Blackfan anemia Dyskeratosis congenita Having a risk factor does not mean a child will develop AML, but children with known risk factors should be monitored closely. Diagnosis of AML in Children Diagnosing AML requires several specialized tests. 1. Blood Tests Complete Blood Count (CBC) with peripheral blood smear This test measures red blood cells, white blood cells, and platelets and examines their appearance under a microscope. 2. Bone Marrow Aspiration and Biopsy A sample of liquid and solid bone marrow is taken (usually from the hipbone) and examined to confirm leukemia. 3. Lumbar Puncture (Spinal Tap) Performed to check whether leukemia has spread to the central nervous system (brain and spinal cord). 4. Specialized Laboratory Tests These tests help determine the exact AML subtype and guide treatment: Cytochemistry Flow cytometry and immunohistochemistry Fluorescent in situ hybridization (FISH) to detect chromosomal changes Treatment of AML in Children Treatment should begin as soon as possible after diagnosis. Therapy is personalized based on the AML subtype and the child’s overall health. Chemotherapy The main treatment for childhood AML, typically given in phases: Induction Phase Intensive chemotherapy to destroy as many leukemia cells as possible. Consolidation Phase Chemotherapy given in cycles to eliminate remaining cancer cells. Maintenance Phase Used in selected high-risk cases to prevent relapse. Targeted Therapy Targeted drugs attack specific genes or proteins that leukemia cells need to survive, sparing healthy cells as much as possible. Radiation Therapy Radiation is not routinely used for AML but may be needed if: Leukemia spreads to the brain or other organs Preparation is required before a bone marrow transplant Bone Marrow (Stem Cell) Transplant High-dose chemotherapy can damage the bone marrow. In such cases, a bone marrow transplant replaces damaged marrow with healthy stem cells, allowing the body to produce normal blood cells again. Key Takeaway Acute myeloid leukemia in children is a serious but treatable disease. Advances in diagnosis, chemotherapy, targeted therapy, and bone marrow transplantation have significantly improved outcomes. Early diagnosis and treatment at a specialized center are critical for the best possible prognosis.