Childhood Acute Myeloid Leukemia - An Overview

Introduction

Acute myeloid leukemia, also known as myelogenous, myelocytic, and myeloblastic leukemia (AML), is a category of malignant diseases marked by abnormal, immature hematopoietic cells that replace normal bone marrow. Despite improvements in the cure rate, medicines come with a significant risk of morbidity and mortality.

What Is Childhood Acute Myeloid Leukemia?

Acute myeloid leukemia is a malignancy of the bone marrow and white blood cells present in the blood. The spongy substance found inside bones, called bone marrow, is where all blood components, including white blood cells, are produced. "Myeloid" refers to the type of white cells that develop into cancer, and "acute" indicates a rapid disease development. Acute myeloid leukemia can strike adults as well as children (AML).

What Are the Causes of Childhood Acute Myeloid Leukemia?

Acute myeloid leukemia in children is uncommon. Bone marrow cells that normally develop into white blood cells are involved in AML. There is not enough room in the bone marrow and blood for healthy red blood cells, white blood cells, and platelet formation due to the accumulation of these leukemia cells. Children with AML are more likely to have the following because there are not enough healthy cells for them to complete their job:

• Anemia (low red blood cell count).

• There is a higher chance of bruises and bleeding.

• Infections.

The majority of the time, acute myeloid leukemia's cause is unknown. Certain factors can raise a child's chance of having acute myeloid leukemia:

• Alcohol or tobacco smoke exposure before birth.

• A medical history of specific conditions, like aplastic anemia.

• Some hereditary illnesses include neurofibromatosis, down syndrome, and other uncommon syndromes.

• Previous intake of medications used in chemotherapy, such as Cyclophosphamide.

• Previous radiation therapy treatment.

• Even if the child has one or more risk factors, cancer is not guaranteed to strike them. The majority of kids with AML do not have any identified risk factors.

What Are the Symptoms of Acute Myeloid Leukemia?

Among the signs and symptoms of acute myeloid leukemia are:

• Feeling worn down or feeble.

• Joint or bone ache.

• Recurring infections.

• Simple bruising or bleeding.

• Fever, either contagious or not.

• Sweats at night.

• Painless lumps may be blue or purple in the groin, stomach, armpits, or neck.

• Bleeding-related pinpoint patches (petechiae) under the skin.

• Breathlessness.

• We have reduced food intake and appetite loss.

Acute myelocytic leukemia (AML) in children manifests as any of the following

There are three types of leukemia symptoms:

• Those resulting from a lack of healthy cells.

• Those brought on by the growth and invasion of the aberrant leukemia cell population.

• Constitutional symptoms.

A lack of regularly functioning cells might cause symptoms such as these:

• Cytopenias: May be brought on by a shortage of healthy cells.

• Anemia: Symptoms include headache, tachycardia, tiredness, and pallor.

• Hemorrhage: Gingival bleeding, petechiae, epistaxis, and easy bruising are signs of bleeding.

• Fever: An infection should always be the original cause.

The following are symptoms brought on by the aberrant leukemic cell mass's proliferation and infiltration, as well as the infiltrative disease:

• Extramedullary Infiltration: This usually occurs in the reticuloendothelial system.

• Mediastinal Mass: This may result in signs of superior vena cava syndrome or respiratory insufficiency.

• Abdominal Masses: This may block the GI or urogenital tracts or cause pain.

• CNS infiltration and gingival hyperplasia are frequently linked to monoblastic leukemia.

What Are the Risk Factors?

Children may be more susceptible to getting AML than other kids if they have specific genetic abnormalities, such as Down syndrome, Bloom syndrome, Fanconi anemia, or Kostmann syndrome. Treatment for a prior cancer may potentially increase a child's risk of getting AML. However, this is uncommon in young patients with myelodysplastic syndrome (MDS) or other bone marrow diseases.

What Is the Diagnosis?

The loss or decrease of normal hematopoietic cells is a defining feature of AML. Typically, anemia is normocytic, meaning the reticulocyte count is lower than expected, proportional to the hemoglobin level. Hemoglobin levels might drop to a very slight or significant level. The following laboratory tests are performed on patients with AML:

• Differential Blood Counts: WBC levels might be low or high, but platelet counts are often low.

• Blood Smears: Auer rods are found in specimens of circulating blood from many AML patients, although they are more noticeable in juvenile acute promyelocytic leukemia (APL). Primitive granulocyte/monocyte precursors have been observed.

• Blood Chemistries: Serum levels of lactate dehydrogenase (LD), muramidase (lysozyme), and uric acid are frequently increased. Blood and urine cultures should always be taken when a child has leukemia and a fever.

• Histochemical Staining: Using standard Wright-Giemsa and histochemical stains to distinguish between acute leukemias. Head, spine, or other affected areas MRI or CT scan.

• CT Scanning of the Abdomen or Sinuses: For the early diagnosis of asymptomatic sinusitis as the source of persistent, unexplained fevers for abdominal pain or suspected big bowel infection.

• Echocardiography: To rule out life-threatening infections that compromise cardiac function; also conducted before chemotherapy and regularly when high cumulative doses of anthracyclines are administered.

• Radionuclide Imaging: To identify hidden infections (such as occult osteomyelitis or deep-tissue infections) that are not visible with cultures or other imaging modalities.

What Is the Treatment?

AML treatment for kids could involve the following:

• Medicines that fight cancer (chemotherapy).

• Specific forms of focused treatment.

• If leukemia does not go away after treatment or does not react well to chemotherapy, a bone marrow transplant is used. High doses of chemotherapy, radiation therapy, and occasionally bone marrow donation from a suitable donor are used in this procedure.

• Transfusions of red blood cells and platelets—cells that help stop bleeding—are a part of supportive care.

Conclusion

Given current chemotherapy, a therapeutic peak has been reached, and the current survival rate for juvenile AML is approximately 70 percent. Because of toxicity, additional therapy intensity is not possible. The various prognostically meaningful, non-randomly linked molecular and cytogenetic abnormalities identified in recent years serve as an example of the heterogeneity of AML. Numerous working events in leukemogenesis, however, still need to be clarified. Shortly, the use of novel techniques—particularly next-generation sequencing—will help to comprehend the genetic makeup of AML and pave the way for creating more specialized and individualized treatments. Teamwork across international borders is essential to achieving such goals for a rare disease like pediatric AML.