AML will usually be treated with chemotherapy, or cancer-killing drugs. Most children respond very well to initial treatment. If leukaemia cells can no longer be seen in their blood or bone marrow under a microscope, their leukaemia is said to be ‘in remission’. Some children with higher risk cancers may need high-dose chemotherapy and a stem cell transplant. Radiotherapy (radiation therapy) is rarely used.
Over the course of your child’s treatment, conventional chemotherapy should take about five or six months and involves four courses of treatment, each lasting four to six weeks.
Your child will initially have two courses of treatment to try to bring about remission (you might hear this called the ‘induction phase’ or ‘remission induction phase)’. Then after remission has been achieved, your child will have two more courses of similar chemotherapy drugs (a consolidation phase) to try to kill remaining leukaemia cells and prevent relapse.
The first course uses intensive treatment to destroy as many leukaemia cells as possible.
Although children may be able to go home for a few days between courses, they might need to stay in hospital for supportive care. The intensity of the treatment and strength of the drugs means your child is likely to need blood transfusions or treatment for infections.
All children, regardless of whether the lumbar puncture tests show leukaemia cells in the cerebrospinal fluid (CSF), will have drugs injected into it. They usually receive two injections: one with their first course of chemotherapy and one with the second, to stop the cancer spreading to the CSF. Drugs given intrathecally (into the CSF) are more effective in doing this than drugs your child could take intravenously (into a vein).
Most children will be in remission at the end of the induction phase but if they then stop treatment, there’s a high chance that the disease will return (relapse). So at the end of induction treatment they move onto what’s known as consolidation therapy.
The purpose of consolidation is to destroy any remaining leukaemia cells and to prevent relapse. Usually, children have two courses of chemotherapy which are very similar to the first two courses they had as part of their remission induction treatment. They then have a further two courses of different, usually higher dose, drugs. One called cytarabine is normally used.
Children may then have a stem cell transplant (rarely) or more typically have two further courses of treatment.
The main form of treatment for childhood AML is chemotherapy, which simply means drug therapy. The drugs used are cytotoxic, meaning they are toxic to cells. Unlike normal cells, cancer cells are out of control – they divide and reproduce rapidly.
Cytotoxic drugs interfere with cell division so a cell that’s dividing is killed. As cancer cells divide more often than normal cells, drugs that prevent cell division kill more cancer cells than normal cells.
Most children with AML respond very well to chemotherapy and don’t need a stem cell transplant as part of their initial treatment.
How drugs can be given
Chemotherapy drugs can be given in a number of ways:
- by mouth (oral) as a tablet or capsule, although this is more rare
- by injection into the spinal fluid (intrathecal)
- by injection into the bloodstream through a vein (intravenous infusion, or drip).
For intravenous infusion, drugs will usually be given directly into a tube, known as a central line, inserted into a large blood vessel. This line is kept in over the whole period that your child is having treatment, so there’s no need for repeated needle-pricks and there’s less risk of infection. Your child shouldn’t feel any discomfort from the line, although some children find the idea of them difficult at first.
You might hear these words mentioned:
- Hickman line – there are a few types of central line that can be put under the skin in your child’s chest; this is the name of one of the most common ones.
- PICC line – a central line that’s put into your child’s arm.
Below are some drug names you may hear mentioned. These drugs are used in various combinations to treat childhood AML:
Drugs given by intravenous drip:
- G-CSF (this drug is only used rarely)
Drugs given by intravenous drip and intrathecal injection:
Drugs given by intrathecal injection:
It’s very unusual for cancer cells to remain in the CSF after chemotherapy drugs have been injected into the spinal fluid. But if this is the case, your child may be given radiotherapy to kill any remaining leukaemia cells. If your child is affected, you’ll have a chance to discuss this with their specialist.
Stem cell transplant
Stem cell transplants are rarely done in AML, unless
- a child is considered high risk
- their cytogenetic tests have pointed to a particular type of genetic fault
- they haven’t responded to treatment as well as hoped, or
- they’ve had a relapse.
Before a stem cell transplant sometimes large doses of chemotherapy and radiotherapy are given, with the aim of destroying existing stem cells and introducing new, healthy blood-producing stem cells to your child’s body – so curing the disease.
Stem cells are given to your child through a drip into a vein (intravenous transfusion); there’s no need for surgery.
Stem cells are collected from the bone marrow or blood of a matched donor – someone who has been tested to make sure their cells are compatible with your child’s. The donor may be a brother or sister but can be unrelated.
Stem cell transplants can only be done if there’s a well-matched donor available. Your child’s consultant will give you detailed advice on the risks and benefits of this type of treatment. It’s an intensive treatment aimed at cure but it can come with side effects, and it’s important that you understand what these are.
> To find out more about stem cell transplants, download or order our booklet The seven steps: blood stem cell and bone marrow transplants
Supportive care is an umbrella term to describe the many ways in which your child’s healthcare team will protect them from infection and minimise discomfort from either the side effects of treatment, or leukaemia symptoms.
Your child may need:
- antibiotics to prevent and treat bacterial infections
- an antibiotic twice a week to reduce the risk of a particular pneumonia
- antifungals to prevent and treat fungal infections
- prednisolone eye drops to prevent conjunctivitis, which may be caused by high doses of cytarabine
- red blood cell and platelet transfusions, because the drugs used to treat AML damage the bone marrow’s ability to produce normal blood cells
- a heart scan (echocardiogram ultrasound) before chemotherapy, because anthracycline drugs (such as daunorubicin and idarubicin) may affect the heart muscle if given in high doses, and your child’s doctor will want to monitor this.
> Find out more information about treatment decisions
You can find out more detailed information on how these drugs are given and their side effects on the Cancer Research UK website.