Treatment AML (https://www.childrenwithcancer.org.

uk/childhood-cancer-info/cancer-types/acute-
myeloid-leukemia/)

The treatment for AML is shorter and more intensive than for ALL. The total duration of treatment for
AML is around six months and children will usually be admitted to hospital for the full duration of their
treatment. This is because the intensive treatment can make children very unwell and they need a high
level of supportive care.

The main treatment is chemotherapy. A combination of chemotherapy drugs and steroid medicines is
given according to a treatment plan (also called a protocol or regimen). There are two phases of
treatment – remission induction and post-remission treatment.

i) Remission induction

The initial aim of treatment for AML is to achieve a state called remission where almost all leukaemic
cells have been killed, allowing production of normal blood cells to resume.

Remission induction usually includes one or two blocks of a combination of chemotherapy drugs in high
doses given over a few days at intervals of one or two weeks.

Children with AML are usually given intrathecal chemotherapy after each of the first two blocks of
chemotherapy. This involves injecting chemotherapy drugs into the spinal fluid to prevent leukaemic
cells from surviving in the brain and spinal cord. Occasionally radiotherapy to the brain may also be
necessary.

ii) Post-remission treatment

Post-remission treatment (also known as consolidation or post-induction treatment) aims to destroy any
remaining leukaemic cells and to prevent the disease from returning. This phase usually involves two or
three more blocks of the same drugs used in remission induction.

Sometimes it is necessary to use additional drugs or higher doses of the same drugs; this is known as
intensification. Stem cell (bone marrow) transplantation is a special case of intensification. It enables
doctors to give higher doses of drugs than would otherwise be possible.

The intensity of treatment needed to treat AML causes severe bone marrow suppression. Expert
supportive care is therefore necessary and the child will usually need to remain in hospital, even during
the gaps between treatment blocks.

All children will continue to be monitored following completion of treatment – for the first year they will
be checked every two or three months. Checks will then gradually become less frequent.

The main purposes of follow-up are detection of relapse and detection of treatment complications.

The role of stem cell transplantation in AML

Stem cell (bone marrow) transplantation is used more often in children with AML than children with ALL.
However its use is still largely limited to children who have experienced relapse.
Children with high-risk disease and some children with standard-risk disease may be considered for a
transplant whilst in first remission.

The role of radiotherapy in AML

Radiotherapy is not routinely used in the treatment of childhood AML. Some children who are found to
have leukaemic cells in their central nervous system may need to have radiotherapy.

Children who are undergoing stem cell transplantation will need radiotherapy as part of the preparation
for the transplant.

Side effects

The treatments used for AML often cause side effects. Most side effects are temporary and can be
minimised with good supportive care. The most common effects include nausea and vomiting, hair loss,
reduced resistance to infection, bruising and bleeding, tiredness and diarrhoea.

Treatments can also cause long-term or ‘late’ effects. These are relatively rare and most children who
survive AML will grow and develop normally.

The main risk of long-term effects is in children who receive cranial and spinal irradiation to prevent
central nervous system (CNS) relapse. Cranial and spinal irradiation is associated with impairment of
growth and educational achievement and with premature onset of puberty. In order to minimise the
risk, only a minority of children receive cranial irradiation routinely and those that do receive the
absolute minimum dose of radiotherapy necessary.

Other documented problems include cardiac problems, fertility problems and a small elevated risk of
second cancers.

Follow-up and relapse

All children will be followed-up at regular intervals following their treatment for AML to monitor their
progress and check for treatment-related problems.

A high proportion of children with AML will achieve remission but up to a quarter of these children will
relapse – their disease will return. Relapse usually occurs within the first three years after treatment.
Although relapsed AML tends to be more resistant to treatment, many children can be successfully re-
treated.

The timing of relapse is significant. Children who relapse a long time after treatment has finished have a
better chance of responding to re-treatment. These children will be considered for a stem cell transplant
if they have not already received one. In children who have already received a transplant, it may be
possible to use immune cells from the original donor to treat a relapse; this is known as donor
lymphocyte infusion (DLI)

The likelihood of a relapse progressively decreases with time, although late relapses do occur.