Acute myeloid leukemia (AML) 3

induction, children with AML receive further intensive treatment with an allogeneic
bone marrow transplant (if a matched sibling donor is available) or more chemo-
therapy, called postremission therapy.
Postremission chemotherapy may include: cytosine arabinoside (in high or standard
doses), etoposide, an anthracycline (doxorubicin, daunorubicin or idarubicin),
thioguanine, amsacrine, azacytidine, and cyclophosphamide. Children with APL also
get ATRA (and in some cases, 6-mercaptopurine and methotrexate) during post-
remission therapy.
In the past, another phase of treatment, called maintenance, was used. This phase
consisted of low-dose chemotherapy given for a number of years. Studies have
shown that additional therapy after intensive induction and consolidation does not
lengthen remission for children with AML.
Bone marrow transplantation (BMT)
BMT is being used increasingly to treat children with AML in first remission. High-
dose chemotherapy, with or without total body radiation, is used to destroy the
child’s bone marrow and any remaining cancer cells. Healthy, matched marrow or
peripheral blood stem cells are taken from a compatible family member and dripped
into the patient’s blood intravenously. The new marrow migrates to the bones and
replaces the destroyed marrow. This is called an allogeneic transplant. Nearly 60
percent of children with AML with matched donors who undergo a BMT in first
remission may be cured by transplantation from a closely matched family donor.
Another method sometimes used for children without a matched, or closely matched,
donor is called autologous BMT. In this type of transplant, marrow is removed from
the child, may be treated chemically to remove leukemia cells, and frozen. After the
child’s own diseased marrow has been destroyed, the frozen marrow is thawed and
returned to the patient intravenously. The data so far indicate that this is no better
than conventional chemotherapy and is inferior to matched allogeneic bone marrow
transplantation.
The role of transplants using bone marrow, peripheral blood, or cord blood from
unrelated donors for childhood AML in first remission has not yet been established.
These are sometimes used to treat AML in second remission or AML that occurs as a
second cancer.
Chapter 20 discusses in detail the types of transplants, procedures, side effects, and
coping suggestions from parents and survivors.
Chloromas are most commonly found in children with M4 and M5 AML. They occur
in approximately 10 percent of all AML patients. Chloromas usually disappear with
standard AML treatment. However, if the location of a chloroma may cause a serious
problem such as vision loss or spinal cord damage, radiation therapy may be given.
Newest treatment options
To learn more about AML, call (800) 422-6237 (800-4-CANCER) and ask for the PDQ
(Physician Data Query) for AML. These free statements, also available on the Internet
at http://www.cancer.gov/cancer_information/pdq/, explain the disease, state-of-the-art
treatments, and ongoing clinical trials. There are two versions available: the version
designed for patients uses simple language and contains no statistics; the version for
professionals is technical, thorough, and includes citations to the scientific literature.