Treating acute myeloid leukaemia (AML)

Children with AML must be admitted to hospital for most of their treatment because of the high level of supportive care required to combat the side-effects of treatment.

There are two phases in the treatment of childhood AML - remission induction and post-remission treatment. The total duration of treatment is much shorter than for ALL as extended maintenance therapy is not required.

Phase I: Remission induction

The first phase involves using intensive treatment to destroy as many of the leukaemia cells as possible.

Remission induction usually includes two blocks of a combination of chemotherapy drugs in high doses given over a few days at intervals of one or two weeks.

The intensity of treatment needed to achieve complete remission causes severe bone marrow suppression, leaving the child prone to bleeding or infection.

Although there are gaps of either one or two weeks between blocks of therapy, children need supportive care to combat these risks and will therefore need to stay in hospital during this time.

As for ALL a potential problem in the treatment of AML is central nervous system (CNS) relapse. Leukaemia cells can enter the cerebro-spinal fluid (CSF) which surrounds the brain and spinal cord and it is necessary for drugs to be injected directly into the spinal fluid to kill any leukaemia cells which may be remain. Radiotherapy may also be required particularly if leukaemia cells are detected in the CSF at the time of diagnosis.

Phase II: Post-remission treatment (also known as consolidation)

Consolidation aims to destroy any remaining leukaemia cells and to stop the disease from returning. This phase usually involves two or three more blocks of chemotherapy.