Cancers and Tumors
Acute Myeloid Leukemia
What is acute myeloid leukemia?
Leukemia is cancer of the blood and bone marrow – the soft center part of bones where blood cells are made.
Acute myeloid leukemia (AML) grows from a type of immature blood cell called a myeloid stem cell. Normally, myeloid stem cells grow to form:
- Most of the white blood cells that fight infection
- Red blood cells that carry oxygen
- Platelets that make the blood clot to stop bleeding
In children with AML, the myeloid cells stay immature and crowd out healthy blood cells.
AML is also called acute myelogenous leukemia.
Almost all children who have leukemia have an acute form. Another acute type is acute lymphoblastic leukemia (ALL). Acute leukemia grows fast and gets worse quickly without treatment. Very few children get chronic leukemia, which develops more slowly.
To have the best chance of a cure, your child needs care from doctors who specialize in treating children with blood cancers. Children with AML also benefit from a team that can meet their physical, emotional, nutritional and other needs. Seattle Children’s Leukemia and Lymphoma Program is that team.
Doctors do not know what causes the changes in cells that lead to leukemia. There is no known way to prevent AML.
Most children who have leukemia have no clear risk factors. But the chance of AML is higher in children who:
- Have a genetic condition such as Down syndrome or Li-Fraumeni syndrome
- Received certain chemotherapy medicines
- Were exposed to chemicals such as benzene
Acute Myeloid Leukemia at Seattle Children’s
The experts in our Leukemia and Lymphoma Program have lots of experience caring for children with all types of leukemia. We provide advanced therapies for children with leukemia that:
- Is newly diagnosed
- Is in active treatment
- Gets better but then gets worse (relapsed)
- Comes back (recurrent)
The Leukemia and Lymphoma Program is part of our Cancer and Blood Disorders Center. Please contact us at 206-987-2106 for more information, a second opinion or to make an appointment.
For the past decade, U.S. News & World Report has consistently ranked Seattle Children's Cancer Center among the best in the nation. In 2017, our program was ranked #1 in the Northwest.
At Seattle Children’s Cancer Center, our survival rates for a wide range of cancers have been significantly better than the national average for 20 years. See our statistics and outcomes.
Through our partnership in the Seattle Cancer Care Alliance (SCCA), our patients benefit from the work of physician-scientists at Fred Hutch and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has designated our partnership a comprehensive cancer center.
Our experience helps us recommend the right treatment at the right time to have the best results for your child and your family.
Our doctors are experts in caring for children with blood cancers and know the most effective ways to treat leukemia. Treatments we offer include anticancer medicine (chemotherapy), stem cell transplants and radiation therapy.
For children who need stem cell transplants, we work closely with Fred Hutch, whose doctors pioneered this lifesaving treatment. Our team is with your family through the whole process – preparing for transplant, doing the transplant here at Seattle Children’s and caring for your child as they recover.
Our childhood cancer doctors meet regularly with transplant doctors to talk about each high-risk leukemia patient in detail and plan their treatment.
Each patient gets a personalized treatment plan. It includes:
- How to get your child’s disease in remission
- The best kind of transplant for your child, if needed
- How to reduce the risk of cancer coming back after transplant
We care for your whole child. We don’t just treat their leukemia. Your family has a full team behind you, including specialists in nutrition, pharmacy, nursing, pain management, physical therapy, social work and emotional health. Read more about the supportive care we offer.
Seattle Children’s is well known for developing promising new leukemia treatments and leading research studies with the goal of improving cure rates. We work hard to find the best research study (clinical trial) for your child.
As a national leader in cancer research, we can offer our patients the very latest treatments being studied, including phase 1 and phase 2 clinical trials. These studies are especially important if your child’s cancer does not respond well to treatment or comes back.
Seattle Children’s is a founding member of the Children’s Oncology Group (COG). COG is an international organization of childhood cancer specialists who work to develop new treatments and reduce later effects of the disease and treatments.
Our clinical trial options for AML include a new anticancer medicine (CPX-351) designed to kill leukemia cells while limiting damage to the heart. The trial is open to young people with relapsed AML. Dr. Todd Cooper chairs this study and will also be leading a national COG phase 3 study for children newly diagnosed with AML.
Cooper is also chair of the COG’s committees on Relapsed AML and New Agents for AML. Search by diagnosis for many clinical trials available through Seattle Children’s and our partners on ClinicalTrials.gov. Read our guide about searching for trials on ClinicalTrials.gov (PDF).
Dr. Soheil Meshinchi focuses on defining the genetic make-up of childhood AML. He works with Dr. Katherine Tarlock and others on the team to:
- Develop better, personalized treatments
- Create more sensitive, accurate ways to monitor disease and effects of treatment
- Find the genetic changes that make some forms of AML harder to cure
Meshinchi holds many leadership roles in COG:
- Chairman of the COG AML Biology Committee
- Director of the COG AML Reference Laboratory
- Co-chair of the COG Myeloid Disease Committee
- Principal investigator for the TARGET AML Initiative to define the genetic and other factors that cause AML and allow it to grow and spread. TARGET is a joint effort by the COG and the National Cancer Institute.
Learn more about AML research at Seattle Children’s.
Children do not react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. They need a healthcare team specially trained to understand and meet their needs.
Our leukemia doctors have special training in how to diagnose and treat children with cancer. Our experts are focused on how treatments today affect growing bodies in the future. They base their treatment plans on years of experience and the newest research on what works best – and most safely – for children.
People who have been cured of cancer may be affected for months or years by their disease or treatment. Our Cancer Survivor Program provides long-term follow-up care to help children and young adults stay healthy after being treated for cancer in childhood.
Learning that your child has leukemia can be scary. We help right away by offering appointments within 1 to 3 days for children who are suspected to have cancer.
During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.
Our child life specialists and social workers help your child and your family through the challenges of cancer. We connect you to community resources and support groups.
At Seattle Children’s, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.
Symptoms of Acute Myeloid Leukemia
Symptoms of acute leukemia tend to appear over a matter of days or weeks and may get worse quickly. Many of the signs and symptoms of AML happen because cancer cells crowd out healthy blood cells in the bone marrow. Other symptoms happen if leukemia cells build up in the lymph nodes or organs (such as the brain, spleen or liver).
These symptoms may be caused by leukemia or by another health condition. Check with a doctor if your child has:
- Fever, which may be a sign of infection. Risk of infection is greater if white blood cell levels are low.
- Easy bruising or bleeding, even from small injuries. This may be a sign of low platelets.
- Weakness, tiredness or feeling dizzy. A lack of red blood cells (anemia) may cause these symptoms.
- Pinpoint spots of blood under the skin caused by tiny broken blood vessels (petechiae). This is another sign of low platelets.
- Spots that look like a skin rash caused by AML cells in the skin.
- Bone or joint pain from cancer cells building up there.
- Painless lumps in the neck, underarm, stomach, groin and around the eyes.
- Pain and fullness under the ribs from an enlarged liver or spleen.
- Swollen belly or loss of appetite. This may happen if the liver or spleen is enlarged.
- Shortness of breath or coughing. This can be caused by swelling of lymph nodes in the chest or swelling of a gland in the neck (thymus) that is part of the immune system.
- Headaches or problems with vision, balance or muscle control. These may happen if leukemia has spread to the brain.
Diagnosing Acute Myeloid Leukemia
To find out whether your child has leukemia, your child’s doctor will:
- Do an exam to check your child’s general health
- Ask about your child’s health and family health history
- Test your child’s blood to tell if any blood cells are unhealthy and, if so, which type
- Do a bone marrow aspiration or biopsy
- Check the spinal fluid for leukemia cells
Common blood tests to check for leukemia include:
- Complete blood count (CBC) – Tells how many cells of each type are moving through the bloodstream
- Peripheral blood smear – Shows how the blood cells look
- Blood chemistry – Finds chemicals in the blood that may be signs of cancer
Doctors may do other blood tests to learn more about the unhealthy cells and help tell which subtype of leukemia your child has. Doctors may:
- Look for proteins on the surface of the cancer cells
- Look at the chromosomes in the cancer cells
Leukemia cells almost always spread quickly from the bone marrow to the blood. They travel through the bloodstream to other parts of the body. These tests help tell if leukemia cells have started to collect in other areas of the body:
- Lumbar puncture: To tell if cancer has spread into the fluid surrounding your child’s brain and spinal cord. This is also called a spinal tap.
- A biopsy: Taking a small tissue sample from the skin or other area where doctors suspect leukemia cells have collected.
- A chest X-ray: To look into the chest area.
Unlike most other cancers, there is not a standard way to describe the stage (extent) of disease for AML.
To classify AML, doctors look at:
- The type of blood-forming cell it affects
- Changes to chromosomes or proteins in or on the leukemia cells
- How the cells look under a microscope
The disease is considered higher risk if the cancer cells have features like abnormal chromosomes or certain proteins on the cell surface. These features mean there is a greater chance of AML not responding well to treatment or coming back after treatment.
Treatment Options for Acute Myeloid Leukemia
Our goal of treatment is to give your child or teen the best chance of a long and healthy life.
We will recommend treatment for your child’s AML based on:
- Your child’s age
- Features of the cancer cells, such as chromosome changes
- The subtype of AML
- Whether AML has spread beyond the blood and bone marrow
- Whether the cancer is newly diagnosed, in remission or has returned after treatment (recurrent)
- How your child’s cancer responds to treatment
- Your child’s overall health
- Your family’s preferences
Before leukemia itself is treated, some children will need treatment for problems like infection, bleeding or anemia. Low levels of healthy blood cells cause these.
Standard treatment for AML is chemotherapy with more than one medicine. Radiation therapy or targeted therapy may be an option in some cases.
If your child’s disease is considered higher risk or comes back after treatment, your doctor may recommend stem cell transplant.
Seattle Children’s offers these treatments:
Chemotherapy means giving medicines that go throughout your child’s body to kill cancer cells. Researchers are testing new mixes of chemotherapy medicines to find the best ones for each type of AML.
Children with AML get chemotherapy through a vein or by mouth. These medicines help kill cancer cells that are in the blood, bone marrow and other places where cancer may have spread.
All children with leukemia also get chemotherapy directly into their spinal fluid. This is to keep the cancer from spreading to the brain and spinal cord or to treat any cancer already there. It is called intrathecal chemotherapy or CNS prophylaxis.
Usually children with AML get chemotherapy for 6 to 9 months. Children with higher-risk disease get about 3 months of chemotherapy followed by stem cell transplant.
Our patients get chemotherapy at our hospital’s main campus in Seattle. Your child may need to stay in our hospital’s Cancer Care Unit for much of their chemotherapy treatment. Expert nurses and doctors will adjust your child’s treatment or supportive care based on how your child is doing.
See more about getting chemotherapy at Seattle Children’s.
For some children with AML, treatment includes a transplant of blood-forming (hematopoietic) stem cells. These are immature cells that grow into different types of blood cells. Doctors may suggest a stem cell transplant:
- Soon after AML is controlled by other treatments, if your child has higher-risk AML
- If your child’s AML comes back after other treatment
First your child will get high doses (amounts) of chemotherapy. They may also get radiation. This kills cancer cells and makes space for new stem cells your child will get during the transplant.
Then your child receives stem cells through their vein. The cells have been taken from a healthy family member or other donor. These healthy cells then create new bone marrow.
A transplant using stem cells from another person is called an allogeneic (pronounced a-low-gen-AY-ik) transplant.
We do the transplants at Seattle Children’s, working closely with our partner in the Seattle Cancer Care Alliance, Fred Hutch.
Learn more about the Pediatric Blood and Marrow Transplant Program.
If your child’s cancer has spread or may spread to the brain, spinal fluid or other places in the body, your child’s doctors may suggest radiation to one of those areas. Doctors also use radiation to prepare a child’s body for a stem cell transplant.
Radiation uses high-energy X-rays to kill cancer cells. A machine outside the body delivers strong beams of X-rays. We focus beams as precisely as possible to help limit damage to healthy areas.
Radiation can harm a child’s developing nervous system, their bones or their ability to have children in the future. Our radiation oncologist, Dr. Ralph Ermoian, is experienced caring for children. He helps your child’s team decide if radiation may be helpful and what type of radiation to use. We work with patients to protect their ability to have biological children (fertility preservation).
Children treated for leukemia at Seattle Children’s receive radiation therapy through our partner, UW Medicine.
Learn more about Seattle Children’s Radiation Therapy Service.
Your child may be offered targeted therapy if their AML cells have a difference in a chromosome or protein that can be targeted with an available drug.
Doctors are studying these and other types of targeted therapies in clinical trials:
- Tyrosine kinase inhibitors (TKIs) block signals that help tumors grow. Blocking the tyrosine kinase enzyme stops stem cells from turning into AML cells. Doctors are studying TKIs combined with chemotherapy to treat AML that is newly diagnosed or in remission.
- Monoclonal antibodies are manmade versions of immune system proteins that fight disease. They target proteins present on the surface of leukemia cells and kill them with a variety of drugs.
Many children, teens and young adults with leukemia take part in research in addition to their standard medical treatment. Seattle Children’s doctors who care for your child also work on new treatments to improve the outlook for all children with blood cancers. Research studies of new drugs and other promising approaches are called clinical or therapeutic trials.
These are examples of the clinical trials we offer for AML:
Learn more about cancer clinical trials at Seattle Children’s
We offer clinical trials:
Treating Recurrent AML
If your child’s AML comes back after treatment, it is called recurrent. Treatment options include:
- More chemotherapy. The drugs used depend on how soon AML comes back after treatment and how well your child can tolerate intensive chemotherapy.
- Stem cell transplant
- A clinical trial testing new mixes of anticancer medicines, targeted therapies or new approaches to stem cell transplant
Follow-up care is important after treatment ends. The follow-up routine will depend on your child’s type of AML and their treatments. Most children visit the Leukemia and Lymphoma Program at Seattle Children’s each month for the first year after active treatment ends. Follow-up visits happen less often as time goes by.
If you do not live in the Seattle area, you can see a doctor in your own community for most follow-up care. Your doctor will let you know the schedule that is right for you.
During follow-up visits we check your child for:
- Any signs that their cancer is returning
- Effects from therapy that may happen months or years after treatment.
Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after being treated for cancer in childhood.
Through our partnership in Seattle Cancer Care Alliance, our patients who have had a stem cell transplant get care from the SCCA’s Long-Term Follow-Up program.
Contact the Cancer and Blood Disorders Center at 206-987-2106 for an appointment, a second opinion or more information.
To make an appointment, you can call us directly or get a referral from your child’s primary care provider. We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children’s.
Providers, see how to refer a patient.