Acute Myeloid Leukemia

What is acute myeloid leukemia (AML)?

Leukemia is cancer of the blood and bone marrow. Acute myeloid leukemia (AML) grows from a type of young blood cell called a myeloid stem cell. In healthy children, these cells grow to form blood cells that fight infection, carry oxygen and make blood clot.

In children with AML, the myeloid cells do not mature. They crowd out healthy blood cells. Doctors do not know what causes the changes in cells that lead to AML. There is no known way to prevent it. AML is also called acute myelogenous leukemia.

In most children, leukemia grows fast and gets worse quickly without treatment. This is called acute. Another acute type is acute lymphoblastic leukemia (ALL).

Acute Myeloid Leukemia at Seattle Children’s

To have the best chance of a cure, your child needs a team of experts experienced in treating AML in children and young adults. Each year our Leukemia and Lymphoma Program team cares for many babies, children, teens and young adults with AML. Some are just starting their first treatment. Others have refractory, relapsed or recurrent cancer. Our entire focus is on helping your child beat AML and thrive.  

If you would like an appointment, ask your primary care provider to refer you to Seattle Children’s Cancer and Blood Disorders Center.

If you have a referral or would like a second opinion, contact the center at 206-987-2106 or by email.

Providers, see how to refer a patient.

  • Among the nation's best cancer programs
    • Your child will benefit from the work of physician-scientists at Fred Hutchinson Cancer Center and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has named our partnership a comprehensive cancer center.
    • Many children are cured of AML with standard treatments. But in about half of young people, their AML comes back (relapses). If that is the case for your child, they will be treated by our team of experts in high-risk leukemia research, diagnostics and treatment.
  • The experts you need are here

    Our doctors are world leaders in improving care and cure rates. Meet the doctors who care for children, teens and young adults with AML

    • Dr. Todd Cooper, co-director of our High Risk Leukemia Program, plays a key role in the global Pediatric Acute Leukemia (PedAL) Initiative that aims to transform treatment for children with acute leukemia. Cooper chairs the Children's Oncology Group's committees on New Agents for AML and Relapsed AML. He leads a national COG study for children with newly diagnosed AML. COG is the largest consortium in the world focused on childhood cancers.
    • Dr. Soheil Meshinchi is an expert in leukemia biology, next-generation sequencing, targeted therapies for AML patients and stem cell transplants for children with leukemia. He provides scientific leadership for many national and worldwide cooperative research efforts. These include the PedAL Initiative, COG AML Biology Committee and the TARGET AML Initiative.
    • Dr. Katherine Tarlock works in the Meshinchi lab to identify genetic changes in AML that can lead to new therapies. She leads 2 national COG clinical trials for targeted therapies in childhood AML. Learn more about the AML lab research at Seattle Children’s.
    • Dr. Adam Lamble leads a national phase 1 clinical trial through COG that is testing a new medicine for relapsed or refractory AML. With Tarlock, he works to test a child’s leukemia cells against many different drugs, with the goal of personalizing their treatment. This is called high-throughput drug screening.
  • Advanced diagnostics and personalized treatment
    • In addition to standard diagnostics, our team uses state-of-the-art tests like molecular profiling and next-generation sequencing (NGS). We examine your child’s cancer cells for certain proteins that can serve as targets for treatment and starting points for the design of new drugs.
    • These tests help us find what is different about your child’s leukemia and identify the best treatment options for them. Whenever possible, we use results from NGS to match your child with therapies that target their specific cancer. This approach is called precision (or personalized) medicine. These therapies could be medicines already approved for another disease or clinical trials of new treatments.
    • In addition to targeted therapies, we offer advanced treatment options such as new mixes of anticancer medicine (chemotherapy), immunotherapy and stem cell transplants.
    • For children who need stem cell transplants, we work closely with Fred Hutch, whose doctors pioneered this lifesaving treatment. Our team works 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.
  • Research to improve care and cure rates

    Seattle Children’s physician-scientists are known worldwide for research on the biology of childhood AML and promising new treatments. Dr. Soheil Meshinchi’s lab works to:

    • Find the genetic changes that make some forms of AML harder to cure
    • Develop better treatments targeted to those genetic changes
    • Create more sensitive, accurate ways to monitor disease and effects of treatment

    We lead research studies of new therapies, with the goal of finding cures for all children with AML. We are key players in the worldwide PedAL Initiative to identify the genetic changes that drive different forms of acute leukemia and create targeted therapies for them. We offer the very latest treatments being studied. These include phase 1 clinical trials, which many centers do not provide.

    Read more about cancer research and clinical trials at Seattle Children’s.

  • Complete care from birth to young adulthood
    • Our specialty is treating children’s cancer while helping them grow up to be healthy and productive adults. We take care of your child from diagnosis through all phases of treatment and follow-up survivor care.
    • Our team cares for your whole child. We don’t just treat their disease. As needed, your child will receive care from specialists in nutrition, pain management, pharmacy, palliative care, physical therapy and emotional health. Read more about the supportive care we offer.
    • 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. Our experts focus on how treatments today affect growing bodies in the future. We plan your child’s treatment based on our years of experience and the newest research on what is best and safest for children.
    • We know that teens and young adults with cancer have different challenges than young children. Our Adolescent and Young Adult Cancer Program focuses on their needs, which may include fertility preservation.
    • 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.
  • Support for your whole family
    • Learning that your child has leukemia can be scary. We help take positive steps right away by offering appointments in 1 to 3 days to children suspected to have cancer.
    • During visits, we take time to explain your child’s condition. We help you fully understand 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.
    • We work with 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 AML 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 or build up in the lymph nodes or other parts of the body.

These symptoms may be caused by AML or by another health problem. Check with a doctor if your child has:

  • Fever, which may be a sign of infection
  • Easy bruising or bleeding, even from small injuries
  • Weakness, tiredness or feeling dizzy
  • Pinpoint spots of blood under the skin caused by tiny broken blood vessels
  • Spots that look like a skin rash
  • Bone or joint pain
  • Painless lumps in the neck, underarm, stomach, groin and around the eyes
  • Pain and fullness under the ribs
  • Swollen belly or loss of appetite
  • Shortness of breath or coughing
  • Headaches or problems with vision, balance or muscle control

Diagnosing Acute Myeloid Leukemia

To find out whether your child has AML, 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

We use next-generation sequencing to find what’s different about your child’s AML. Doctors may do other tests to learn more about the unhealthy cells and help tell which subtype of AML your child has. These tests check:

  • Proteins on the surface of the cancer cells
  • The chromosomes in the cancer cells
  • Tests to check for spread of cancer

    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
    • Biopsy
    • Imaging studies such as a chest X-ray
  • Classifying AML

    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

    AML 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. If your child has high-risk leukemia, they will get advanced care from our High-Risk Leukemia Program.

Treating Acute Myeloid Leukemia

Our goal of treatment is to give your child or teen the best chance of a long and healthy life. Your child’s healthcare team works with you to cure your child’s disease, support your family during treatment, prevent serious side effects and provide follow-up care.

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, is in remission or has relapsed
  • How your child’s cancer responds to treatment
  • Your child’s overall health
  • Your family’s preferences

We treat most children’s AML with chemotherapy using more than 1 medicine. Some children also need targeted therapy. Children with a form of AML called acute promyelocytic leukemia (APL) need different treatment.

If your child’s disease is higher risk or comes back after treatment, your doctor may recommend stem cell transplant. Your child will get care from experts in our High-Risk Leukemia Program.

  • Chemotherapy

    Chemotherapy means giving medicines that go throughout your child’s body to kill cancer cells. These medicines help kill cancer cells that are in the blood, bone marrow and other places where cancer may have spread. The medicines and timing of treatment will depend on your child’s AML.

    Children with AML get chemotherapy through a vein or by mouth. All children with AML 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.

    Most children with AML get chemotherapy for 6 to 9 months. Those with higher-risk disease get about 3 months of chemotherapy followed by stem cell transplant.

    Our patients get chemotherapy at our hospital campus in Seattle. Your child may need to stay in our hospital’s Cancer Care Unit for much of their chemotherapy treatment. Sometimes they will get infusions during daytime visits to our outpatient clinic. Expert nurses and doctors will adjust your child’s treatment and supportive care based on how your child is doing.

    See more about getting chemotherapy at Seattle Children’s.

  • Stem cell transplant

    For some children with AML, treatment includes a transplant of hematopoietic (him-at-oh-poy-EH-tik) stem cells. These are young cells that grow into different types of blood cells. Doctors may recommend 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

    We do the transplants at Seattle Children’s, working closely with our partner in the Seattle Cancer Care Alliance, Fred Hutch.

    First your child will get large amounts (high doses) of chemotherapy. They may also get radiation therapy. This kills cancer cells and makes space for the 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 (a-low-gen-AY-ik) transplant.

    Learn more about the Pediatric Blood and Marrow Transplant Program.

  • Targeted therapies

    Targeted therapy may be an option if your child’s AML cells have a difference in a chromosome or a protein that can be targeted with an existing medicine or a therapy offered in a research study. Examples are:

    • Tyrosine kinase inhibitors (TKIs) that stop stem cells from turning into AML cells.
    • Immune system proteins (antibodies) made in the lab to fight disease. Some are used to carry chemotherapy to cancer cells. They are called antibody drug conjugates.
  • Clinical trials

    Many children with AML take part in research studies along with their standard medical treatment. Your child’s doctor will talk with you about any new options that might help your child. Then you can decide if you want to take part. It is always your choice.

    We offer clinical trials of treatments developed here at Seattle Children’s and through our membership in the Children's Oncology Group, the Pediatric Early Phase-Clinical Trial Network and the Therapeutic Advances in Childhood Leukemia (TACL) consortium. 

  • Supportive care

    AML and the intense treatment needed to fight it may cause severe symptoms and side effects for your child. Having low levels of healthy blood cells lowers their body’s ability to fight infection, make blood clot and carry oxygen around the body. We treat problems like infection, bleeding or anemia along with treating their AML. Some children need to be treated in the hospital until they have enough healthy cells to fight infection.

    As needed, your child will get transfusions to replace lost blood cells and antibiotics to treat or prevent infections. Expert nurses and doctors will watch your child closely. Based on how your child is doing, we adjust your child’s treatment and supportive care.

    We provide many types of supportive care to ease your child’s symptoms and side effects. As needed, specialists in nutrition, pain management, pharmacy, palliative care and emotional health will help care for your child. 

Treating Relapsed AML

Many children are cured of AML with standard treatments. But in about half of children and young adults, AML comes back (relapses). If this happens, your child will need a new approach to treatment. Experts in our High-Risk Leukemia Program leave no stone unturned to improve survival for children with the toughest cases of AML.

Treatment options include:

  • A clinical trial testing new mixes of anticancer medicines, targeted therapies or new approaches to stem cell transplant.
  • 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.

Follow-up Care

Follow-up care is important after treatment ends. The follow-up routine will depend on your child’s type of AML and their treatments. Your doctor will let you know the schedule that is right for your child.

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.

Contact Us

If you would like an appointment, ask your child’s primary care provider to refer you.

If you have a referral or would like a second opinion, contact the Cancer and Blood Disorders Center at 206-987-2106 or by email.

Providers, see how to refer a patient.

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