Treatment and side effects for childhood acute myeloid leukaemia (AML)
The aim of treatment for AML is to get rid of the leukaemia cells and help your child’s bone marrow to work normally again.
The main treatment for childhood AML is chemotherapy (treatment with anti-cancer drugs). The particular treatment your child has will depend on their individual condition and general health. Doctors will explain the treatment they recommend, and you will be able to ask questions and make choices as the parent or carer of a child under 16.
Older children will be consulted about their own treatment choices, although most will want their family closely involved.
AML can develop rapidly, so it’s vital your child receives effective treatment soon after their diagnosis has been confirmed.
Doctors will use information from your child’s tests to assess your child’s level of risk. Risk is the chance of something happening – in this case, it’s the chance that the AML will come back (relapse) after treatment.
For childhood AML, there are three risk groups:
- high risk.
Your child’s risk group may change, depending on how well their treatment is working. Risk grouping is just a way of deciding what treatment is best at a particular point. A child with high risk AML may respond just as well to treatment as a child with intermediate or standard risk AML – it’s about choosing the best treatment in the particular circumstances.
Some children can be quite ill when AML is first diagnosed. Doctors may need to get them better so they can cope with the drugs used to treat AML. They may have:
- infections, because they have a low number of white blood cells
- anaemia – pale skin, tiredness and breathlessness because of low numbers of red blood cells
- bleeding, because they don’t have enough platelets and other substances needed for blood clotting
- breathing, heart or kidney problems because of the presence of leukaemia cells.
Your child may be given antibiotics and blood or platelets to help with these problems before they start chemotherapy. Some children may be best supported in an intensive care unit.
Treatment for childhood AML
All children with AML will have treatment with chemotherapy (anti-cancer drugs).
Chemotherapy for childhood AML usually involves a combination of drugs given into a vein (intravenously). We have more information about managing your child's treatment and how drugs are given (central lines).
Stages of treatment
This first stage of treatment is called induction. Your child will have two rounds of chemotherapy as their induction treatment. The aim is to get them into remission, and most children respond well.
The next stage of treatment is called consolidation. This aims to kill any leukaemia cells that are left after induction treatment and stop the AML coming back (relapsing).
For children and young adults with standard and intermediate risk AML, consolidation is normally two more rounds of chemotherapy using a different combination of drugs. For children and young adults with high risk AML, consolidation will involve a stem cell transplant.
Each round or course of chemotherapy lasts four to six weeks. If your child has standard or intermediate risk AML, treatment will take a total of five to six months. If your child has high risk AML, treatment may take longer.
Doctors will do more tests after each course of chemotherapy to see how successful the treatment has been. Based on the results, your child’s level of risk may change and this will help doctors recommend the next course of treatment.
Your child may be able to go home for a few days in between each course of chemotherapy, but they will probably need to stay in hospital most of the time during treatment. This is because the chemotherapy drugs are very strong and your child may need blood transfusions and urgent treatment for infections.
Treating AML in the cerebrospinal fluid
Sometimes, leukaemia cells can be found in the fluid (known as cerebrospinal fluid or CSF) that surrounds the brain and spinal cord. Even if a lumbar puncture test shows no leukaemia cells in the CSF, children and young adults will have chemotherapy drugs injected into their spine to make sure the leukaemia doesn’t spread to the CSF.
This procedure is called an intrathecal injection. Your child will have an intrathecal injection with their first and second courses of chemotherapy.
Stem cell transplant
If test results show that your child has a high risk of relapse (the AML coming back), they will be offered a stem cell transplant as their consolidation treatment. This means your child will receive blood stem cells from another healthy individual (a donor).
Find out more about stem cell transplants.
Side effects are the unwanted effects of treatment. There are some potential short-term and long-term side effects from treatment for childhood AML.
It’s important to understand that all children are different and that although the list of potential side effects may be worrying, they’re unlikely to get all of them. Your healthcare team will also have effective treatments to help your child cope with some of the side effects. This is known as supportive care.
We have general information on side effects from treatment for childhood leukaemia, and supportive care to help with these side effects.
When your child’s treatment has finished, they will continue to come to the hospital for regular check-ups. As time passes after treatment, these will happen less and less often.
Remission and relapse
After treatment, most children will go into remission, where there is no sign of leukaemia. But the leukaemia may come back (relapse). If this happens they will have similar tests to when they were originally diagnosed. Treatment options will include a stem cell transplant, if they haven’t already had one. Children who relapse a long time after their treatment has finished have a better chance of responding well to more treatment.
Tests like MRD and genetics are designed to help identify children who are at higher risk of relapse, so they can have stronger treatment at the beginning. The aim of stronger treatment is to stop relapse happening.
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