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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65864_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65864_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65864_"><span class="title" itemprop="name">Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: March 28, 2018.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000258000__361">This PDQ cancer information summary has current information about the treatment of childhood acute myeloid leukemia and other myeloid malignancies. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000258000__362">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.</p></div><div id="CDR0000258000__1"><h2 id="_CDR0000258000__1_">General Information About Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258000__326">Childhood acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__218">Leukemia and other diseases of the blood and bone marrow may affect red blood cells, white blood cells, and platelets.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__222">Other myeloid diseases can affect the blood and bone marrow.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258000__374">Transient abnormal myelopoiesis (TAM)</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__378">Acute promyelocytic leukemia (APL)</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__227">Juvenile myelomonocytic leukemia (JMML)</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__224">Chronic myelogenous leukemia (CML)</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__233">Myelodysplastic syndromes (MDS)</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258000__316">AML or MDS may occur after treatment with certain chemotherapy drugs and/or radiation therapy. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__15">The risk factors for childhood AML, APL, JMML, CML, and MDS are similar.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__19">Signs and symptoms of childhood AML, APL, JMML, CML, or MDS include
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fever, feeling tired, and easy bleeding or bruising.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__23">Tests that examine the blood and bone marrow are used to detect
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(find) and diagnose childhood AML, TAM, APL, JMML, CML, and MDS.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__27">Certain factors affect prognosis (chance
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of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000258000__326"><h3>Childhood acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells.</h3><p id="CDR0000258000__328">Childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">acute myeloid leukemia</a> (AML) is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, and acute nonlymphocytic leukemia. Cancers that are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045585/" class="def">acute</a> usually get worse quickly if they are not treated. Cancers that are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">chronic</a> usually get worse slowly.</p><div id="CDR0000258000__332" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20bone&p=BOOKS&id=493020_CDR0000755927.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000755927.jpg" alt="Anatomy of the bone; drawing shows spongy bone, red marrow, and yellow marrow. A cross section of the bone shows compact bone and blood vessels in the bone marrow. Also shown are red blood cells, white blood cells, platelets, and a blood stem cell." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the bone. The bone is made up of compact bone, spongy bone, and bone marrow. Compact bone makes up the outer layer of the bone. Spongy bone is found mostly at the ends of bones and contains red marrow. Bone marrow is found in the center of most bones and has many blood vessels. There are two types of bone marrow: red and yellow. Red marrow contains blood stem cells that can become red blood cells, white blood cells, or platelets. Yellow marrow is made mostly of fat.</p></div></div></div><div id="CDR0000258000__218"><h3>Leukemia and other diseases of the blood and bone marrow may affect red blood cells, white blood cells, and platelets.</h3><p id="CDR0000258000__220">Normally,
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the bone marrow makes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000765906/" class="def">blood stem cells</a> (immature <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a>) that become mature blood cells over time. A blood stem cell may become a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046279/" class="def">myeloid</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">stem cell</a> or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046298/" class="def">lymphoid</a> stem cell. A lymphoid stem cell becomes a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cell</a>. </p><p id="CDR0000258000__329">A myeloid stem cell becomes one of three types of mature blood cells: </p><ul id="CDR0000258000__221"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">Red blood cells</a> that carry <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a> and other substances to all
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> of the body.</div></li><li class="half_rhythm"><div>White blood cells that fight <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> and disease.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">Platelets</a> that form <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476017/" class="def">blood clots</a> to
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stop bleeding.</div></li></ul><div id="CDR0000258000__266" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Blood%20cell%20development&p=BOOKS&id=493020_CDR0000526538.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000526538.jpg" alt="Blood cell development; drawing shows the steps a blood stem cell goes through to become a red blood cell, platelet, or white blood cell. A myeloid stem cell becomes a red blood cell, a platelet, or a myeloblast, which then becomes a granulocyte (the types of granulocytes are eosinophils, basophils, and neutrophils). A lymphoid stem cell becomes a lymphoblast and then becomes a B-lymphocyte, T-lymphocyte, or natural killer cell." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell. </p></div></div><p id="CDR0000258000__330">In AML, the myeloid stem cells usually become a type of immature white blood cell called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000742483/" class="def">myeloblasts</a> (or myeloid <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blasts</a>). The myeloblasts, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> cells, in AML are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> and do not become healthy white blood cells. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045360/" class="def">anemia</a>, or easy bleeding may occur.</p><p id="CDR0000258000__373"> The leukemia cells can spread outside the blood to other parts of the body, including the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>), skin, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gums</a>. Sometimes leukemia cells form a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045301/" class="def">solid tumor</a> called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335098/" class="def">granulocytic sarcoma</a>
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or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335063/" class="def">chloroma</a>.</p></div><div id="CDR0000258000__222"><h3>Other myeloid diseases can affect the blood and bone marrow.</h3><div id="CDR0000258000__374"><h4>Transient abnormal myelopoiesis (TAM)</h4><p id="CDR0000258000__376">TAM is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407758/" class="def">disorder</a> of the bone marrow that can develop in newborns who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045488/" class="def">Down syndrome</a>. It usually goes away on its own within the first 3 months of life. Infants who have TAM have an increased chance of developing AML before the age of 3 years. TAM is also called transient <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045210/" class="def">myeloproliferative disorder</a> or transient leukemia. </p></div><div id="CDR0000258000__378"><h4>Acute promyelocytic leukemia (APL)</h4><p id="CDR0000258000__380"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444957/" class="def">APL</a> is a subtype of AML. In APL, some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosome</a> 15 switch places with some genes on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000737156/" class="def">chromosome 17</a> and an abnormal gene called <i>PML-RARA</i> is made. The <i>PML-RARA</i> gene sends a message that stops promyelocytes (a type of white blood cell) from maturing. The promyelocytes (leukemia cells) can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. Problems with severe bleeding and blood clots may also occur. This is a serious health problem that needs treatment as soon as possible.</p></div><div id="CDR0000258000__227"><h4>Juvenile myelomonocytic leukemia (JMML)</h4><p id="CDR0000258000__229"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045048/" class="def">JMML</a> is a rare <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000728326/" class="def">childhood cancer</a> that occurs more often in children around the age of 2 years and is more common in boys. In JMML, too many myeloid blood stem cells become myelocytes and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046282/" class="def">monocytes</a> (two types of white blood cells). Some of these myeloid blood stem cells never become mature white blood cells. These immature cells, called blasts, are unable to do their usual work. Over time, the myelocytes, monocytes, and blasts crowd out the red blood cells and platelets in the bone marrow. When this happens, infection, anemia, or easy bleeding may occur.</p></div><div id="CDR0000258000__224"><h4>Chronic myelogenous leukemia (CML)</h4><p id="CDR0000258000__226"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044382/" class="def">CML</a> often begins in an early myeloid blood cell when a certain gene change occurs. A section of genes, that includes the <i>ABL</i> gene, on chromosome 9 changes place with a section of genes on chromosome 22, which has the <i>BCR</i> gene. This makes a very short chromosome 22 (called the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044179/" class="def">Philadelphia chromosome</a>) and a very long chromosome 9. An abnormal <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000561237/" class="def">BCR-ABL</a></i> gene is formed on chromosome 22. The <i>BCR-ABL</i> gene tells the blood cells to make too much of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> called tyrosine kinase. Tyrosine kinase causes too many white blood cells (leukemia cells) to be made in the bone marrow. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur. CML is rare in children.<div id="CDR0000258000__423" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Philadelphia%20chromosome&p=BOOKS&id=493020_CDR0000533336.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000533336.jpg" alt="Philadelphia chromosome; three-panel drawing shows a piece of chromosome 9 and a piece of chromosome 22 breaking off and trading places, creating a changed chromosome 22 called the Philadelphia chromosome. In the left panel, the drawing shows a normal chromosome 9 with the abl gene and a normal chromosome 22 with the bcr gene. In the center panel, the drawing shows chromosome 9 breaking apart in the abl gene and chromosome 22 breaking apart below the bcr gene. In the right panel, the drawing shows chromosome 9 with the piece from chromosome 22 attached and chromosome 22 with the piece from chromosome 9 containing part of the abl gene attached. The changed chromosome 22 with bcr-abl gene is called the Philadelphia chromosome." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Philadelphia chromosome. A piece of chromosome 9 and a piece of chromosome 22 break off and trade places. The bcr-abl gene is formed on chromosome 22 where the piece of chromosome 9 attaches. The changed chromosome 22 is called the Philadelphia chromosome.</p></div></div></p></div><div id="CDR0000258000__233"><h4>Myelodysplastic syndromes (MDS)</h4><p id="CDR0000258000__235"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">MDS</a> occur less often in children than in adults. In MDS, the bone marrow makes too few red blood cells, white blood cells, and platelets. These blood cells may not mature and enter the blood. The type of MDS depends on the type of blood cell that is affected.</p><p id="CDR0000258000__415">The treatment for MDS depends on how low the numbers of red blood cells, white blood cells, or platelets are. Over time, MDS may become AML.</p><p id="CDR0000258000__236">This summary is about childhood AML, TAM, childhood APL, JMML, childhood CML, and childhood MDS.
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See the <a href="/books/n/pdqcis/CDR0000258001/">Childhood Acute Lymphoblastic Leukemia Treatment</a> summary for information about the treatment of childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">acute lymphoblastic leukemia</a>.</p></div></div><div id="CDR0000258000__316"><h3>AML or MDS may occur after treatment with certain chemotherapy drugs and/or radiation therapy. </h3><p id="CDR0000258000__318">Cancer treatment with certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> may cause therapy-related AML (t-AML) or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>-related MDS (t-MDS). The risk of these therapy-related myeloid diseases depends on the total <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of the chemotherapy drugs used and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> dose and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044741/" class="def">treatment field</a>. Some patients also have an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">inherited</a> risk for t-AML and t-MDS. These therapy-related diseases usually occur within 7 years after treatment, but are rare in children.</p></div><div id="CDR0000258000__15"><h3>The risk factors for childhood AML, APL, JMML, CML, and MDS are similar.</h3><p id="CDR0000258000__17">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk. These and other factors may increase the risk of childhood AML, APL, JMML, CML, and MDS:</p><ul id="CDR0000258000__18"><li class="half_rhythm"><div>Having a brother or sister, especially a twin, with leukemia.</div></li><li class="half_rhythm"><div>Being Hispanic.</div></li><li class="half_rhythm"><div>Being exposed to cigarette smoke or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcohol</a> before birth. </div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">personal history</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045479/" class="def">aplastic anemia</a>.</div></li><li class="half_rhythm"><div>Having a personal or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">family history</a> of MDS.</div></li><li class="half_rhythm"><div>Having a family history of AML.</div></li><li class="half_rhythm"><div>Past treatment with chemotherapy or radiation therapy.</div></li><li class="half_rhythm"><div>Being exposed to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430698/" class="def">ionizing radiation</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643008/" class="def">chemicals</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270734/" class="def">benzene</a>.</div></li><li class="half_rhythm"><div>Having certain inherited disorders or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045090/" class="def">syndromes</a>, such as:<dl id="CDR0000258000__306" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Down syndrome.</p></dd><dt>-</dt><dd><p class="no_top_margin">Aplastic anemia.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045499/" class="def">Fanconi anemia</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045096/" class="def">Neurofibromatosis type 1</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000683528/" class="def">Noonan syndrome</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000644776/" class="def">Shwachman-Diamond syndrome</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046322/" class="def">Li-Fraumeni syndrome</a>.</p></dd></dl></div></li></ul></div><div id="CDR0000258000__19"><h3>Signs and symptoms of childhood AML, APL, JMML, CML, or MDS include
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fever, feeling tired, and easy bleeding or bruising.</h3><p id="CDR0000258000__21">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by childhood AML, APL, JMML, CML, or MDS or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>. Check with a doctor if your child has any of the following:</p><ul id="CDR0000258000__22"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a> with or without an infection.</div></li><li class="half_rhythm"><div>Night sweats.</div></li><li class="half_rhythm"><div>Shortness of breath.</div></li><li class="half_rhythm"><div>Weakness or feeling tired.</div></li><li class="half_rhythm"><div>Easy bruising or bleeding.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046236/" class="def">Petechiae</a> (flat, pinpoint spots under the skin caused by bleeding).</div></li><li class="half_rhythm"><div>Pain in the bones or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458080/" class="def">joints</a>.</div></li><li class="half_rhythm"><div>Pain or feeling of fullness below the ribs.</div></li><li class="half_rhythm"><div>Painless lumps in the neck, underarm, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>, or other parts of the body. In childhood AML, these lumps, called leukemia cutis, may be blue or purple.</div></li><li class="half_rhythm"><div>Painless lumps that are sometimes around the eyes. These lumps, called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335063/" class="def">chloromas</a>, are sometimes seen in childhood AML and may be blue-green.</div></li><li class="half_rhythm"><div>An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000462675/" class="def">eczema</a>-like skin rash.</div></li></ul><p id="CDR0000258000__238">The signs and symptoms of TAM may include the following:</p><ul id="CDR0000258000__239"><li class="half_rhythm"><div>Swelling all over the body.</div></li><li class="half_rhythm"><div>Shortness of breath.</div></li><li class="half_rhythm"><div>Trouble breathing.</div></li><li class="half_rhythm"><div>Weakness or feeling tired.</div></li><li class="half_rhythm"><div>Bleeding a lot, even from a small cut.</div></li><li class="half_rhythm"><div>Petechiae (flat, pinpoint spots under the skin caused by bleeding).</div></li><li class="half_rhythm"><div>Pain below the ribs.</div></li><li class="half_rhythm"><div>Skin rash.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046328/" class="def">Jaundice</a> (yellowing of the skin and whites of the eyes).</div></li><li class="half_rhythm"><div>Headache, trouble seeing, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450096/" class="def">confusion</a>.</div></li></ul><p id="CDR0000258000__377">Sometimes TAM does not cause any symptoms at all and is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> after a routine <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000688783/" class="def">blood test</a>. </p></div><div id="CDR0000258000__23"><h3>Tests that examine the blood and bone marrow are used to detect
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(find) and diagnose childhood AML, TAM, APL, JMML, CML, and MDS.</h3><p id="CDR0000258000__25">The following tests and procedures may be used:</p><ul id="CDR0000258000__26"><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">Complete blood count</a> (CBC) with differential</b>: A procedure in which a sample of blood is drawn and checked for the following:
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<dl id="CDR0000258000__104" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">
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The number of red blood cells and platelets.</p></dd><dt>-</dt><dd><p class="no_top_margin">The number and type of white blood cells.</p></dd><dt>-</dt><dd><p class="no_top_margin">The amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (the protein that carries <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a>) in the red blood cells.</p></dd><dt>-</dt><dd><p class="no_top_margin">The portion of the blood sample made up of red blood cells.
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</p></dd></dl><div id="CDR0000258000__256" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Complete%20blood%20count%20(CBC)&p=BOOKS&id=493020_CDR0000526546.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000526546.jpg" alt="Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.</p></div></div></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of cells or tissues so they can be viewed under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> to check for signs of cancer. Biopsies that may be done include the following:<dl id="CDR0000258000__115" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046505/" class="def">Bone marrow aspiration</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046506/" class="def">biopsy</a></b>: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000549425/" class="def">breastbone</a>.<div id="CDR0000258000__363" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Bone%20marrow%20aspiration%20and%20biopsy&p=BOOKS&id=493020_CDR0000775458.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000775458.jpg" alt="Bone marrow aspiration and biopsy; drawing shows a child lying face down on a table and a bone marrow needle being inserted into the right hip bone. An inset shows the bone marrow needle being inserted through the skin into the bone marrow of the hip bone." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Bone marrow aspiration and biopsy. After a small area of skin is numbed, a bone marrow needle is inserted into the child’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.</p></div></div></p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">Tumor</a> biopsy</b>: A biopsy of a chloroma may be done.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph node</a> biopsy</b>: The removal of all or part of a lymph node. </p></dd></dl>
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</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000341450/" class="def">Immunophenotyping</a></b>: A process used to identify cells, based on the types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046086/" class="def">antigens</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045776/" class="def">markers</a> on the surface of the cell, that may include special staining of the blood and bone marrow cells. This process is used to diagnose the subtype of AML by comparing the cancer cells to normal cells of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270737/" class="def">Cytogenetic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390238/" class="def">analysis</a></b>: A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">laboratory test</a> in which cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes. Changes in the chromosomes may include when part of one chromosome is switched with part of another chromosome, part of one chromosome is missing or repeated, or part of one chromosome is turned upside down.</div><div class="half_rhythm">The following test is a type of cytogenetic analysis:<dl id="CDR0000258000__324" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000460228/" class="def">FISH</a> (fluorescence in situ hybridization)</b>: A laboratory technique used to look at genes or chromosomes in cells and tissues. Pieces of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light.</p></dd></dl></div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000766166/" class="def">Molecular testing</a></b>: A laboratory test to check for certain genes, proteins, or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045065/" class="def">molecules</a> in a sample of blood or bone marrow. Molecular tests also check for certain changes in a gene or chromosome that may cause or affect the chance of developing AML. A molecular test may be used to help plan treatment, find out how well treatment is working, or make a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046303/" class="def">Lumbar puncture</a></b>: A procedure used to collect a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF) from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396787/" class="def">spinal column</a>. This is done by placing a needle between two bones in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> and into the CSF around the spinal cord and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs that leukemia cells have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap.<div id="CDR0000258000__268" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Lumbar%20puncture&p=BOOKS&id=493020_CDR0000503953.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000503953.jpg" alt="Lumbar puncture; drawing shows a patient lying in a curled position on a table and a spinal needle (a long, thin needle) being inserted into the lower back. Inset shows a close-up of the spinal needle inserted into the cerebrospinal fluid (CSF) in the lower part of the spinal column." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing.</p></div></div></div></li></ul></div><div id="CDR0000258000__27"><h3>Certain factors affect prognosis (chance
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of recovery) and treatment options.</h3><p id="CDR0000258000__105">The prognosis (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options for childhood AML depend on the following:</p><ul id="CDR0000258000__106"><li class="half_rhythm"><div>The age of the child when the cancer is diagnosed.</div></li><li class="half_rhythm"><div>The race or ethnic group of the child.</div></li><li class="half_rhythm"><div>Whether the child is greatly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304742/" class="def">overweight</a>.</div></li><li class="half_rhythm"><div> Number of white blood cells in the blood at
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diagnosis.</div></li><li class="half_rhythm"><div>Whether the AML occurred after previous cancer treatment.</div></li><li class="half_rhythm"><div>The subtype of AML.</div></li><li class="half_rhythm"><div>Whether there are certain chromosome or gene changes in the leukemia cells.</div></li><li class="half_rhythm"><div>Whether the child has Down syndrome. Most children with AML and Down syndrome can be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318813/" class="def">cured</a> of their leukemia.</div></li><li class="half_rhythm"><div>Whether the leukemia is in the central nervous system (brain and spinal cord).</div></li><li class="half_rhythm"><div>How quickly the leukemia responds to treatment.</div></li><li class="half_rhythm"><div>Whether the AML is newly diagnosed (untreated) or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a> (come back) after being treated.</div></li><li class="half_rhythm"><div>The length of time since treatment ended, for AML that has recurred.</div></li></ul><p id="CDR0000258000__416">The prognosis for childhood APL depends on the following:</p><ul id="CDR0000258000__417"><li class="half_rhythm"><div> Number of white blood cells in the blood at
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diagnosis.</div></li><li class="half_rhythm"><div>Whether there are certain chromosome or gene changes in the leukemia cells.</div></li><li class="half_rhythm"><div>Whether the APL is newly diagnosed (untreated) or has recurred (come back) after being treated.</div></li></ul><p id="CDR0000258000__240">The prognosis and treatment options for JMML depend on the following:</p><ul id="CDR0000258000__241"><li class="half_rhythm"><div>The age of the child when the cancer is diagnosed.</div></li><li class="half_rhythm"><div>The type of gene affected and the number of genes that have changes.</div></li><li class="half_rhythm"><div>How many red blood cells, white blood cells, or platelets are in the blood.</div></li><li class="half_rhythm"><div>How much hemoglobin is in the blood.</div></li><li class="half_rhythm"><div>Whether the JMML is newly diagnosed (untreated) or has recurred after treatment.</div></li></ul><p id="CDR0000258000__242">The prognosis and treatment options for childhood CML depend on the following:</p><ul id="CDR0000258000__418"><li class="half_rhythm"><div>How long it has been since the patient was diagnosed.</div></li><li class="half_rhythm"><div>How many blast cells are in the blood.</div></li><li class="half_rhythm"><div>Whether and how fully the blast cells disappear from the blood and bone marrow after therapy has started.</div></li><li class="half_rhythm"><div>Whether the CML is newly diagnosed (untreated) or has recurred after treatment.</div></li></ul><p id="CDR0000258000__173">The prognosis and treatment options for MDS depend on the following:</p><ul id="CDR0000258000__174"><li class="half_rhythm"><div>Whether the MDS was caused by previous cancer treatment.</div></li><li class="half_rhythm"><div>How low the numbers of red blood cells, white blood cells, or platelets are.</div></li><li class="half_rhythm"><div>Whether the MDS is newly diagnosed (untreated) or has recurred after treatment.</div></li></ul></div></div><div id="CDR0000258000__30"><h2 id="_CDR0000258000__30_">Stages of Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258000__127">Once childhood acute myeloid leukemia (AML) has been diagnosed, tests are done to find out if the cancer has spread to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__164">
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There is no standard staging system for childhood AML, childhood acute promyelocytic leukemia (APL), juvenile myelomonocytic leukemia (JMML), childhood chronic myelogenous leukemia (CML), or myelodysplastic syndromes (MDS).
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__419">Recurrent childhood AML has
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come back after it has been treated.</a></div></li></ul></div><div id="CDR0000258000__127"><h3>Once childhood acute myeloid leukemia (AML) has been diagnosed, tests are done to find out if the cancer has spread to other parts of the body.</h3><p id="CDR0000258000__325">The following tests and procedures may be used to determine if the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> has spread from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> to other parts of the body:</p><ul id="CDR0000258000__139"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046303/" class="def">Lumbar puncture</a></b>: A procedure used to collect a sample of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (CSF) from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396787/" class="def">spinal column</a>. This is done by placing a needle between two bones in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> and into the CSF around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> and removing a sample of the fluid. The sample of CSF is checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> that leukemia <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>, or skin</b>: The removal of cells or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> from the testicles, ovaries, or skin so they can be viewed under a microscope to check for signs of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. This is done only if something unusual about the testicles, ovaries, or skin is found during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a>.</div></li></ul></div><div id="CDR0000258000__164"><h3>
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There is no standard staging system for childhood AML, childhood acute promyelocytic leukemia (APL), juvenile myelomonocytic leukemia (JMML), childhood chronic myelogenous leukemia (CML), or myelodysplastic syndromes (MDS).
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</h3><p id="CDR0000258000__141">The extent or spread of cancer is usually described as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stages</a>. Instead of stages, treatment of childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044363/" class="def">AML</a>, childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000522912/" class="def">APL</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450126/" class="def">JMML</a>, childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044382/" class="def">CML</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000743926/" class="def">MDS</a> is based on one or more of the following: </p><ul id="CDR0000258000__358"><li class="half_rhythm"><div>The type of disease or the subtype of AML.</div></li><li class="half_rhythm"><div>Whether leukemia has spread outside the blood and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>.</div></li><li class="half_rhythm"><div>Whether the disease is newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a>, in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>.</div></li></ul><p id="CDR0000258000__128"><b>Newly diagnosed childhood AML</b></p><p id="CDR0000258000__129">Newly diagnosed childhood AML has not been treated except to relieve signs and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">fever</a>, bleeding, or pain, and one of the following is found:</p><ul id="CDR0000258000__130"><li class="half_rhythm"><div class="half_rhythm">More than 20% of the cells in the bone marrow are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blasts</a> (leukemia cells).</div><div class="half_rhythm"><i>or</i></div></li><li class="half_rhythm"><div class="half_rhythm">Less than 20% of the cells in the bone marrow are blasts and there is a specific change in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosome</a>.</div></li></ul><p id="CDR0000258000__131"><b>Childhood AML in remission</b></p><p id="CDR0000258000__132">In childhood AML in remission, the disease has been treated and the following are found:</p><ul id="CDR0000258000__133"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045107/" class="def">complete blood count</a> is almost normal.</div></li><li class="half_rhythm"><div>Less than 5% of the cells in the bone marrow are blasts (leukemia cells).</div></li><li class="half_rhythm"><div>There are no signs or symptoms of leukemia in the brain, spinal cord, or other parts of the body.</div></li></ul></div><div id="CDR0000258000__419"><h3>Recurrent childhood AML has
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come back after it has been treated.</h3><p id="CDR0000258000__421">In recurrent childhood AML, the cancer may come back in the blood and bone marrow or in other
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parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">central nervous system</a> (brain and spinal cord).</p><p id="CDR0000258000__422">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045863/" class="def">refractory</a> childhood AML, the cancer does not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">respond</a> to treatment.</p></div></div><div id="CDR0000258000__36"><h2 id="_CDR0000258000__36_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258000__37">There are different types of treatment for children with acute myeloid leukemia (AML), transient abnormal myelopoiesis (TAM), acute promyelocytic leukemia (APL), juvenile myelomonocytic leukemia (JMML), chronic myelogenous leukemia (CML), and myelodysplastic syndromes (MDS). </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__41">Treatment is planned by a team of health care providers who are experts in treating childhood
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leukemia and other diseases of the blood.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__275">Some cancer treatments cause side effects months or years
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after treatment has ended.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__143">The treatment of childhood AML usually has two phases.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__46">Seven types of standard treatment are used for childhood AML, childhood CML, JMML, or MDS.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258000__48">Chemotherapy </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__124">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__148">Stem cell transplant</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__335">Targeted therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__151">Other drug therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__161">Watchful waiting</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__246">Supportive care</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258000__51"> New types of treatment are being tested in clinical trials.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__260">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__262">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258000__264">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000258000__37"><h3>There are different types of treatment for children with acute myeloid leukemia (AML), transient abnormal myelopoiesis (TAM), acute promyelocytic leukemia (APL), juvenile myelomonocytic leukemia (JMML), chronic myelogenous leukemia (CML), and myelodysplastic syndromes (MDS). </h3><p id="CDR0000258000__39">Different types of treatment are available for children with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044363/" class="def">AML</a>, TAM, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000522912/" class="def">APL</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450126/" class="def">JMML</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044382/" class="def">CML</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">MDS</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment),
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and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical
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trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research
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study</a> meant to help improve current treatments or obtain information on new
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treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new
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treatment is better than the standard
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treatment, the new treatment may become the standard treatment.</p><p id="CDR0000258000__40">Because AML and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046279/" class="def">myeloid</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407758/" class="def">disorders</a> are rare in children, taking part in a clinical trial
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should be considered. Some clinical trials are open only to patients who have not yet started treatment. </p></div><div id="CDR0000258000__41"><h3>Treatment is planned by a team of health care providers who are experts in treating childhood
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leukemia and other diseases of the blood.</h3><p id="CDR0000258000__43">Treatment will be overseen by a
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000693555/" class="def">pediatric oncologist</a>, a doctor who specializes
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in treating children with cancer. The pediatric oncologist works with
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other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000650566/" class="def">healthcare providers</a> who are experts in treating children
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with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">leukemia</a> and who specialize in certain areas of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482419/" class="def">medicine</a>. These may
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include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478785/" class="def">specialists</a>:</p><ul id="CDR0000258000__44"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000757278/" class="def">Pediatrician</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046370/" class="def">Hematologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046290/" class="def">Medical
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oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318823/" class="def">Pediatric surgeon</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046546/" class="def">Radiation
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oncologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046267/" class="def">Neurologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318818/" class="def">Neuropathologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318819/" class="def">Neuroradiologist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318821/" class="def">Pediatric nurse specialist</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044730/" class="def">Social worker</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000318825/" class="def">Rehabilitation specialist</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044716/" class="def">Psychologist</a>.</div></li></ul></div><div id="CDR0000258000__275"><h3>Some cancer treatments cause side effects months or years
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after treatment has ended.
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</h3><p id="CDR0000258000__277">Regular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> exams are very important. Some cancer treatments cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> that continue or appear months or years after cancer treatment has ended. These are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. Late effects of cancer treatment may include:</p><ul id="CDR0000258000__278"><li class="half_rhythm"><div>Physical problems.</div></li><li class="half_rhythm"><div>Changes in mood, feelings, thinking, learning, or memory.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">Second cancers</a> (new types of cancer).</div></li></ul><p id="CDR0000258000__279">Some late effects may be treated or controlled. It is important that parents of children who are treated for AML or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> diseases talk with their doctors about the effects cancer treatment can have on their child. (See the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summary on <a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a> for more information).
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</p></div><div id="CDR0000258000__143"><h3>The treatment of childhood AML usually has two phases.</h3><p id="CDR0000258000__145">The treatment of childhood AML is done in phases:</p><ul id="CDR0000258000__146"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045736/" class="def">Induction therapy</a>: This is the first phase of treatment. The goal is to kill the leukemia <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the blood and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045622/" class="def">bone marrow</a>. This puts the leukemia into <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">Consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification therapy</a>: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> is to kill any remaining leukemia cells that are hiding and may not be active but could begin to regrow and cause a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapse</a>.</div></li></ul><p id="CDR0000258000__147">Treatment called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367432/" class="def">central nervous system (CNS) sanctuary therapy</a> may be given during the induction phase of therapy. Because standard <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> may not reach leukemia cells in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045643/" class="def">CNS</a> (brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>), the cells are able to find <i>sanctuary</i> (hide) in the CNS. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal chemotherapy</a> is able to reach leukemia cells in the CNS. It is given to kill the leukemia cells and lessen the chance the leukemia will <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recur</a> (come back). CNS sanctuary therapy is also called CNS prophylaxis.</p></div><div id="CDR0000258000__46"><h3>Seven types of standard treatment are used for childhood AML, childhood CML, JMML, or MDS.</h3><div id="CDR0000258000__48"><h4>Chemotherapy </h4><p id="CDR0000258000__95">Chemotherapy is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a> (intrathecal chemotherapy), an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> is treatment using more than one chemotherapy drug. </p><p id="CDR0000258000__160">The way the chemotherapy is given depends on the type of cancer being treated. In AML, chemotherapy given by mouth or vein or directly into the cerebrospinal fluid is used.</p><p id="CDR0000258000__245">In AML, the leukemia cells may also spread to the brain and/or spinal cord. Chemotherapy given by mouth or vein to treat AML may not cross the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046504/" class="def">blood-brain barrier</a> to get into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> that surrounds the brain and spinal cord. Instead, chemotherapy is injected into the fluid-filled space to kill leukemia cells that may have spread there (intrathecal chemotherapy).<div id="CDR0000258000__269" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Intrathecal%20chemotherapy&p=BOOKS&id=493020_CDR0000539773.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000539773.jpg" alt="Intrathecal chemotherapy; drawing shows the cerebrospinal fluid (CSF) in the brain and spinal cord, and an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). Top section shows a syringe and needle injecting anticancer drugs into the Ommaya reservoir. Bottom section shows a syringe and needle injecting anticancer drugs directly into the cerebrospinal fluid in the lower part of the spinal column." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Intrathecal chemotherapy. Anticancer drugs are injected into the intrathecal space, which is the space that holds the cerebrospinal fluid (CSF, shown in blue). There are two different ways to do this. One way, shown in the top part of the figure, is to inject the drugs into an Ommaya reservoir (a dome-shaped container that is placed under the scalp during surgery; it holds the drugs as they flow through a small tube into the brain). The other way, shown in the bottom part of the figure, is to inject the drugs directly into the CSF in the lower part of the spinal column, after a small area on the lower back is numbed. </p></div></div></p><p id="CDR0000258000__297">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Myeloid Leukemia</a> for more information.</p></div><div id="CDR0000258000__124"><h4>Radiation therapy</h4><p id="CDR0000258000__126"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. There are two types of radiation therapy: </p><ul id="CDR0000258000__364"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000258000__360">The way the radiation therapy is given depends on the type of the cancer being treated. In childhood AML, external radiation therapy may be used to treat a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335063/" class="def">chloroma</a> that does not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">respond</a> to chemotherapy.</p></div><div id="CDR0000258000__148"><h4>Stem cell transplant</h4><p id="CDR0000258000__150"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> is a way of replacing blood-forming cells that are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> (leukemia cells or MDS cells), or normal healthy cells, that were destroyed by chemotherapy or radiation therapy. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046598/" class="def">Stem cells</a> (immature blood cells) are removed from the blood or bone marrow of the patient or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a> and are frozen and stored. After the cancer treatment is completed, the stored stem cells are thawed and given back to the patient through an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. These <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">reinfused</a> stem cells grow into (and restore) the body's blood cells.</p><div id="CDR0000258000__357" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Stem%20cell%20transplant&p=BOOKS&id=493020_CDR0000765030.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65864.7/bin/CDR0000765030.jpg" alt="Stem cell transplant; (Panel 1): Drawing of stem cells being removed from a patient or donor. Blood is collected from a vein in the arm and flows through a machine that removes the stem cells; the remaining blood is returned to a vein in the other arm. (Panel 2): Drawing of a health care provider giving a patient treatment to kill blood-forming cells. Chemotherapy is given to the patient through a catheter in the chest. (Panel 3): Drawing of stem cells being given to the patient through a catheter in the chest." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Stem cell transplant. (Step 1): Blood is taken from a vein in the arm of the donor. The patient or another person may be the donor. The blood flows through a machine that removes the stem cells. Then the blood is returned to the donor through a vein in the other arm. (Step 2): The patient receives chemotherapy to kill blood-forming cells. The patient may receive radiation therapy (not shown). (Step 3): The patient receives stem cells through a catheter placed into a blood vessel in the chest.</p></div></div></div><div id="CDR0000258000__335"><h4>Targeted therapy</h4><p id="CDR0000258000__336"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Types of targeted therapy include the following:</p><ul id="CDR0000258000__337"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">Tyrosine kinase inhibitor</a> therapy:</b> Tyrosine kinase inhibitor (TKI) therapy blocks signals needed for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> to grow. TKIs block the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> (tyrosine kinase) that causes stem cells to become more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046503/" class="def">blasts</a>) than the body needs. TKIs may be used with chemotherapy drugs as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a> (treatment given after the initial treatment, to lower the risk that the cancer will come back).
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<dl id="CDR0000258000__338" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">Imatinib</a> is a type of TKI that is approved to treat childhood CML. </p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000509041/" class="def">Sorafenib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000484435/" class="def">dasatinib</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000575396/" class="def">nilotinib</a> are being studied in the treatment of childhood leukemia.</p></dd></dl></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibody</a> therapy:</b> Monoclonal antibody therapy uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044918/" class="def">antibodies</a> made in the laboratory, from a single type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material directly to cancer cells.
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<dl id="CDR0000258000__340" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045569/" class="def">Gemtuzumab</a> is a type of anti-CD33 monoclonal antibody that is attached to a chemotherapy drug. It is used in the treatment of AML.</p></dd></dl></div></li></ul><p id="CDR0000258000__381">Selinexor is a targeted therapy drug that is being studied to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045863/" class="def">refractory</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood AML.</p><p id="CDR0000258000__301">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Leukemia</a> for more information.</p></div><div id="CDR0000258000__151"><h4>Other drug therapy</h4><p id="CDR0000258000__308"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393761/" class="def">Lenalidomide</a> may be used to lessen the need for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046001/" class="def">transfusions</a> in patients who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">myelodysplastic syndromes</a> caused by a specific <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046470/" class="def">chromosome</a> change. It is also being studied in the treatment of children with recurrent and refractory AML.</p><p id="CDR0000258000__153"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046018/" class="def">Arsenic trioxide</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367465/" class="def">all-trans retinoic acid</a> (ATRA) are drugs that kill certain types of leukemia cells, stop the leukemia cells from dividing, or help the leukemia cells mature into white blood cells. These drugs are used in the treatment of acute promyelocytic leukemia.</p><p id="CDR0000258000__299">See <a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Myeloid Leukemia</a> for more information.</p></div><div id="CDR0000258000__161"><h4>Watchful waiting</h4><p id="CDR0000258000__163"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045942/" class="def">Watchful waiting</a> is closely <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454803/" class="def">monitoring</a> a patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> without giving any treatment until <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> appear or change. It is sometimes used to treat MDS or transient abnormal myelopoiesis (TAM).</p></div><div id="CDR0000258000__246"><h4>Supportive care</h4><p id="CDR0000258000__248"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046609/" class="def">Supportive care</a> is given to lessen the problems caused by the disease or its treatment. All patients with leukemia receive supportive care treatments. Supportive care may include the following:</p><ul id="CDR0000258000__249"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046001/" class="def">Transfusion</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>: A way of giving <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a>, white blood cells, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a> to replace blood cells destroyed by disease or cancer treatment.
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The blood may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donated</a> from another person or it may have been taken from the patient earlier and stored until needed.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651195/" class="def">Drug therapy</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">antibiotics</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046085/" class="def">antifungal agents</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045252/" class="def">Leukapheresis</a>: A procedure in which a special machine is used to remove white blood cells from the blood. Blood is taken from the patient and put through a blood cell separator where the white blood cells are removed. The rest of the blood is then returned to the patient's bloodstream. Leukapheresis is used to treat patients with very high white blood cell counts.</div></li></ul></div></div><div id="CDR0000258000__51"><h3> New types of treatment are being tested in clinical trials.
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</h3><p id="CDR0000258000__259">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000258000__342"><h4>Immunotherapy</h4><p id="CDR0000258000__344"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biological therapy.</p></div></div><div id="CDR0000258000__260"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000258000__260_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000258000__260_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000258000__260_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000258000__262"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000258000__262_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000258000__262_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000258000__264"><h3>Follow-up tests may be needed.</h3><p id="CDR0000258000__264_55">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000258000__264_56">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000258000__97"><h2 id="_CDR0000258000__97_">Treatment Options for Childhood Acute Myeloid Leukemia</h2><p id="CDR0000258000__382">Treatment of newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">acute myeloid leukemia</a> (AML) during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045736/" class="def">induction</a> phase may include the following:</p><ul id="CDR0000258000__383"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045569/" class="def">gemtuzumab</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000437045/" class="def">Central nervous system sanctuary therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a>, for patients with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335098/" class="def">granulocytic sarcoma</a> (chloroma) if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> does not work.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a>, for patients with therapy-related AML.</div></li></ul><p id="CDR0000258000__384">
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Treatment of childhood AML during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a> phase (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification therapy</a>) depends on the subtype of AML and may include the following:
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</p><ul id="CDR0000258000__385"><li class="half_rhythm"><div>Combination chemotherapy.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">High-dose chemotherapy</a> followed by stem cell transplant using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000765906/" class="def">blood stem cells</a> from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>.
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</div></li></ul><p id="CDR0000258000__386">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045863/" class="def">refractory</a> childhood AML may
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include the following:</p><ul id="CDR0000258000__387"><li class="half_rhythm"><div>Chemotherapy and targeted therapy (selinexor).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393761/" class="def">Lenalidomide</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.</div></li><li class="half_rhythm"><div>A new combination chemotherapy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a>.</div></li></ul><p id="CDR0000258000__388"> Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood AML may
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include the following:</p><ul id="CDR0000258000__389"><li class="half_rhythm"><div>Combination chemotherapy.</div></li><li class="half_rhythm"><div>Combination chemotherapy and stem cell
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transplant, for patients who have had a second complete remission.</div></li></ul></div><div id="CDR0000258000__390"><h2 id="_CDR0000258000__390_">Treatment Options for Transient Abnormal Myelopoiesis or Children with Down Syndrome and AML</h2><p id="CDR0000258000__391">Transient abnormal myelopoiesis (TAM) usually goes away on its own. For TAM that does not go away on its own or causes other health problems, treatment may include the following:</p><ul id="CDR0000258000__392"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046609/" class="def">Supportive care</a>, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046001/" class="def">transfusion</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045252/" class="def">leukapheresis</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li></ul><p id="CDR0000258000__393">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">acute myeloid leukemia</a> (AML) in children aged 4 years or younger who have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045488/" class="def">Down syndrome</a> may include the following:</p><ul id="CDR0000258000__394"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> plus <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000437045/" class="def">central nervous system sanctuary therapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal chemotherapy</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new chemotherapy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045864/" class="def">regimen</a> that depends on how the child <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044085/" class="def">responds</a> to initial chemotherapy.</div></li></ul><p id="CDR0000258000__395">Treatment of AML in children older than 4 years who have Down syndrome may be the same as treatment for children without Down syndrome.</p></div><div id="CDR0000258000__396"><h2 id="_CDR0000258000__396_">Treatment Options for Childhood Acute Promyelocytic Leukemia</h2><p id="CDR0000258000__397">Treatment of newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444957/" class="def">acute promyelocytic leukemia</a> (APL) may include the following:</p><ul id="CDR0000258000__398"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367465/" class="def">All-trans retinoic acid</a> (ATRA) plus <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046018/" class="def">Arsenic trioxide</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of ATRA and arsenic trioxide therapy with or without chemotherapy.</div></li></ul><p id="CDR0000258000__399">Treatment of childhood APL during the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045867/" class="def">remission</a> phase (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045654/" class="def">consolidation</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000350230/" class="def">intensification therapy</a>) may include the following:</p><ul id="CDR0000258000__400"><li class="half_rhythm"><div>All-trans retinoic acid (ATRA) plus chemotherapy.</div></li></ul><p id="CDR0000258000__401">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood APL may include the following:</p><ul id="CDR0000258000__402"><li class="half_rhythm"><div>Arsenic trioxide therapy.</div></li><li class="half_rhythm"><div>All-trans retinoic acid therapy (ATRA) plus chemotherapy.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">monoclonal antibody</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045569/" class="def">gemtuzumab</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000765906/" class="def">blood stem cells</a> from the patient or a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>.</div></li></ul></div><div id="CDR0000258000__405"><h2 id="_CDR0000258000__405_">Treatment Options for Juvenile Myelomonocytic Leukemia</h2><p id="CDR0000258000__406">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045048/" class="def">juvenile myelomonocytic leukemia</a> (JMML) may include the following:</p><ul id="CDR0000258000__407"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>. If JMML <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurs</a> after stem cell transplant, a second stem cell transplant may be done.</div></li></ul></div><div id="CDR0000258000__408"><h2 id="_CDR0000258000__408_">Treatment Options for Childhood Chronic Myelogenous Leukemia</h2><p id="CDR0000258000__409">Treatment for childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044901/" class="def">chronic myelogenous leukemia</a> (CML) may include the following:</p><ul id="CDR0000258000__410"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044833/" class="def">tyrosine kinase inhibitor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib</a>).</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of a new targeted therapy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drug</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000575396/" class="def">nilotinib</a>).</div></li></ul><p id="CDR0000258000__411">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045863/" class="def">refractory</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> childhood CML may include the following:</p><ul id="CDR0000258000__412"><li class="half_rhythm"><div>Targeted therapy with a tyrosine kinase inhibitor (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000484435/" class="def">dasatinib</a> or nilotinib).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000765906/" class="def">blood stem cells</a> from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>.</div></li><li class="half_rhythm"><div>A clinical trial of a new targeted therapy drug (nilotinib).</div></li></ul></div><div id="CDR0000258000__403"><h2 id="_CDR0000258000__403_">Treatment Options for Childhood Myelodysplastic Syndromes</h2><p id="CDR0000258000__404">Treatment of childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">myelodysplastic syndromes</a> (MDS) may include the following:</p><ul id="CDR0000258000__413"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000765906/" class="def">blood stem cells</a> from a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donor</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046609/" class="def">Supportive care</a>, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046001/" class="def">transfusion</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">antibiotics</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000393761/" class="def">Lenalidomide</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>, for patients with certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> changes.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a>.</div></li></ul><p id="CDR0000258000__414">If the MDS becomes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">acute myeloid leukemia</a> (AML), treatment will be the same as treatment for newly <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> AML.</p></div><div id="CDR0000258000__253"><h2 id="_CDR0000258000__253_">To Learn More About Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies</h2><p id="CDR0000258000__254">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about childhood acute myeloid leukemia and other myeloid malignancies, see the following:</p><ul id="CDR0000258000__300"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/drugs/leukemia" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Acute Myeloid Leukemia</a></div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/myeloproliferative-neoplasms" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Myeloproliferative Neoplasms</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/stem-cell-transplant/stem-cell-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Blood-Forming Stem Cell Transplants</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/targeted-therapies-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Cancer Therapies</a></div></li></ul><p id="CDR0000258000__253_44">For more childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other general cancer resources, see the following:</p><ul id="CDR0000258000__253_45"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000373791/">Late Effects of Treatment for Childhood Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/publications/patient-education/guide-for-parents" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Children with Cancer: A Guide for Parents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer in Children and Adolescents</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000258000__AboutThis_1"><h2 id="_CDR0000258000__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000258000__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000258000__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000258000__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000258000__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000258000__AboutThis_6">This PDQ cancer information summary has current information about the treatment of childhood acute myeloid leukemia and other myeloid malignancies. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000258000__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000258000__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000258000__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000258000__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000258000__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000258000__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000258000__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000258000__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000258000__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000258000__AboutThis_21">PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/leukemia/patient/child-aml-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/leukemia/patient/child-aml-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389303]</p><p id="CDR0000258000__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000258000__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000258000__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000258000__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000258000__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65864.7/?report=reader">PubReader</a></li><li><a href="/books/NBK65864.7/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65864" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65864" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment (PDQ®): Patient Version. 2018 Mar 28. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65864.20/">NBK65864.20</a></span> June 5, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65864.19/">NBK65864.19</a></span> March 4, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65864.18/">NBK65864.18</a></span> 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href="/books/NBK65864.8/">NBK65864.8</a></span> April 19, 2018</li><li><span class="bk_col_itm">NBK65864.7</span> March 28, 2018 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65864.6/">NBK65864.6</a></span> March 6, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65864.5/">NBK65864.5</a></span> July 28, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65864.4/">NBK65864.4</a></span> February 5, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65864.3/">NBK65864.3</a></span> October 1, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65864.2/">NBK65864.2</a></span> September 17, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65864.1/">NBK65864.1</a></span> June 25, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000258000__1" ref="log$=inpage&link_id=inpage">General Information About Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies</a></li><li><a href="#CDR0000258000__30" ref="log$=inpage&link_id=inpage">Stages of Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies</a></li><li><a href="#CDR0000258000__36" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000258000__97" ref="log$=inpage&link_id=inpage">Treatment Options for Childhood Acute Myeloid Leukemia</a></li><li><a href="#CDR0000258000__390" ref="log$=inpage&link_id=inpage">Treatment Options for Transient Abnormal Myelopoiesis or Children with Down Syndrome and AML</a></li><li><a href="#CDR0000258000__396" ref="log$=inpage&link_id=inpage">Treatment Options for Childhood Acute Promyelocytic Leukemia</a></li><li><a href="#CDR0000258000__405" ref="log$=inpage&link_id=inpage">Treatment Options for Juvenile Myelomonocytic Leukemia</a></li><li><a href="#CDR0000258000__408" ref="log$=inpage&link_id=inpage">Treatment Options for Childhood Chronic Myelogenous Leukemia</a></li><li><a href="#CDR0000258000__403" ref="log$=inpage&link_id=inpage">Treatment Options for Childhood Myelodysplastic Syndromes</a></li><li><a href="#CDR0000258000__253" ref="log$=inpage&link_id=inpage">To Learn More About Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies</a></li><li><a href="#CDR0000258000__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" 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xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Rhabdomyosarcoma Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Rhabdomyosarcoma Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389283" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Acute Lymphoblastic Leukemia Treatment (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Acute Lymphoblastic Leukemia Treatment (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389303" 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