Description

AML is a cancer that begins in the blood-forming tissues of the bone marrow—the spongy center of the bones that produces blood cells. In AML, the bone marrow creates too many immature granulocytes (a type of white cell) that cannot perform their normal function of fighting infection. As the bone marrow floods the bloodstream with immature white cells, production of healthy white cells, red cells (which carry oxygen), and platelets (which form clots to stop bleeding) slows and stops. The blood carries the leukemic cells to organs such as the lungs, liver, spleen, and kidneys. The cancer can also cross the blood-brain barrier and invade the central nervous system (CNS)—made up of the brain and spinal cord.

AML is grouped into subtypes by the presence of genetic abnormalities in the leukemia cells. AML that doesn’t fall into these categories is grouped into eight different subtypes of AML—M0 to M7—based on cell shape and chemical properties.

Treatment

Treatment for AML is intensive. Treatment is ordinarily divided into two or three phases: 1) induction (to attain remission), 2) stem cell transplantation or post-remission consolidation, and/or 3) post-remission intensification. Maintenance therapy is no longer used in most current protocols. Intrathecal (through a needle into the spine) chemotherapy is used to prevent leukemia in the CNS.

Late effects of treatment for acute myelogenous leukemia

Some children who were treated with chemotherapy alone have few or no long-term effects. Children who had stem cell transplants or children who relapsed and require more intensive treatment may experience more late effects. The following information briefly outlines some common and uncommon late effects from treatment. Remember that you may develop none, a few, or several of these problems in the months or years after treatment ends.

Heart problems. Heart problems can occur months or years after treatment with anthracyclines (i.e., doxorubicin, idarubicin, or daunorubicin), high-dose cyclophosphamide, and chest radiation. Symptoms include shortness of breath, fatigue, wheezing, anxiety, poor exercise tolerance, rapid heartbeat, and irregular heartbeat. The number of AML survivors who develop this late effect is small, but regular checkups are crucial. Survivors often have no symptoms, but problems may be found on cardiac tests such as echocardiograms, electrocardiograms (EKGs), Exercise Stress Test (EST) and Holter monitors. For more information, see Chapter 13, Heart and Blood Vessels.

Fatigue. After treatment for AML, most children resume normal activities at age-appropriate levels, but some children have fatigue. These children, usually those who have received cranial radiation and/or had stem cell transplants, may have long-term troubles with strength, coordination, and weakness. For more information, see Chapter 8, Fatigue.

Dental problems. Dental abnormalities such as failure of the teeth to develop, arrested root development, unusually small teeth, and enamel abnormalities occasionally occur after chemotherapy or radiation. For more information, see Chapter 12, Head and Neck.

Less common problems. Less common late effects include bladder problems (i.e., hemorrhagic cystitis and bladder fibrosis) from cyclophosphamide and osteonecrosis (death of blood vessels that nourish bones) from high-dose steroids. Children who receive cranial radiation have a small risk of developing a secondary cancer. Those treated with VP-16 have a slight chance of a second leukemia, which usually develops within 3 to 5 years after treatment. For more information, see Chapter 20, Subsequent Malignancies.

See information about the late effects of stem cell transplants in section at the end of this chapter, Stem Cell Transplantation Late effects.