Acute Myeloid Leukemia

Leukemia cells almost always spread quickly from the bone marrow to the blood. They travel through the bloodstream to other parts of the body. These tests help tell if leukemia cells have started to collect in other areas of the body:

• Lumbar puncture
• Biopsy
• Imaging studies such as a chest X-ray

Unlike most other cancers, there is not a standard way to describe the stage (extent) of disease for AML.

To classify AML, doctors look at:

• The type of blood-forming cell it affects
• Changes to chromosomes or proteins in or on the leukemia cells
• How the cells look under a microscope

AML is considered higher risk if the cancer cells have features like abnormal chromosomes or certain proteins on the cell surface. These features mean there is a greater chance of AML not responding well to treatment or coming back after treatment. If your child has high-risk leukemia, they will get advanced care from our High-Risk Leukemia Program.

Chemotherapy means giving medicines that go throughout your child’s body to kill cancer cells. These medicines help kill cancer cells that are in the blood, bone marrow and other places where cancer may have spread. The medicines and timing of treatment will depend on your child’s AML.

Children with AML get chemotherapy through a vein or by mouth. All children with AML also get chemotherapy directly into their spinal fluid. This is to keep the cancer from spreading to the brain and spinal cord or to treat any cancer already there.

Most children with AML get chemotherapy for 6 to 9 months. Those with higher-risk disease get about 3 months of chemotherapy followed by stem cell transplant.

Our patients get chemotherapy at our hospital campus in Seattle. Your child may need to stay in our hospital’s Cancer Care Unit for much of their chemotherapy treatment. Sometimes they will get infusions during daytime visits to our outpatient clinic. Expert nurses and doctors will adjust your child’s treatment and supportive care based on how your child is doing.

See more about getting chemotherapy at Seattle Children’s.

For some children with AML, treatment includes a transplant of hematopoietic (him-at-oh-poy-EH-tik) stem cells. These are young cells that grow into different types of blood cells. Doctors may recommend a stem cell transplant:

• Soon after AML is controlled by other treatments if your child has higher-risk AML
• If your child’s AML comes back after other treatment

We do the transplants at Seattle Children’s, working closely with our partner in the Seattle Cancer Care Alliance, Fred Hutch.

First your child will get large amounts (high doses) of chemotherapy. They may also get radiation therapy. This kills cancer cells and makes space for the new stem cells your child will get during the transplant.

Then your child receives stem cells through their vein. The cells have been taken from a healthy family member or other donor. These healthy cells then create new bone marrow. A transplant using stem cells from another person is called an allogeneic (a-low-gen-AY-ik) transplant.

Learn more about the Pediatric Blood and Marrow Transplant Program.

Targeted therapy may be an option if your child’s AML cells have a difference in a chromosome or a protein that can be targeted with an existing medicine or a therapy offered in a research study. Examples are:

• Tyrosine kinase inhibitors (TKIs) that stop stem cells from turning into AML cells.
• Immune system proteins (antibodies) made in the lab to fight disease. Some are used to carry chemotherapy to cancer cells. They are called antibody drug conjugates.

Many children with AML take part in research studies along with their standard medical treatment. Your child’s doctor will talk with you about any new options that might help your child. Then you can decide if you want to take part. It is always your choice.

We offer clinical trials of treatments developed here at Seattle Children’s and through our membership in the Children's Oncology Group, the Pediatric Early Phase-Clinical Trial Network and the Therapeutic Advances in Childhood Leukemia (TACL) consortium. 

AML and the intense treatment needed to fight it may cause severe symptoms and side effects for your child. Having low levels of healthy blood cells lowers their body’s ability to fight infection, make blood clot and carry oxygen around the body. We treat problems like infection, bleeding or anemia along with treating their AML. Some children need to be treated in the hospital until they have enough healthy cells to fight infection.

As needed, your child will get transfusions to replace lost blood cells and antibiotics to treat or prevent infections. Expert nurses and doctors will watch your child closely. Based on how your child is doing, we adjust your child’s treatment and supportive care.

We provide many types of supportive care to ease your child’s symptoms and side effects. As needed, specialists in nutrition, pain management, pharmacy, palliative care and emotional health will help care for your child. 

As leaders in pediatric cancer research, we can offer options that are not available at all centers, such as phase 1 clinical trials of the newest treatments. Options offered at Seattle Children’s include:

• Clinical trials offered through the Children's Oncology Group, the Pediatric Early Phase-Clinical Trial Network, the Therapeutic Advances in Childhood Leukemia (TACL) consortium and drug companies.
• New ways to prepare children for transplant if they do not have a fully matched stem cell donor.

Learn more about cancer clinical trials at Seattle Children’s

• You can search for many clinical trials available through Seattle Children’s on our Current Research Studies page or on ClinicalTrials.gov. Read our guide about searching for trials on ClinicalTrials.gov (PDF).
• Contact us at 206-987-2106.
• Email us.

• Your child will benefit from the work of physician-scientists at Fred Hutchinson Cancer Center and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has named our partnership a comprehensive cancer center.
• Many children are cured of AML with standard treatments. But in about half of young people, their AML comes back (relapses). If that is the case for your child, they will be treated by our team of experts in high-risk leukemia research, diagnostics and treatment.

Our doctors are world leaders in improving care and cure rates. Meet the doctors who care for children, teens and young adults with AML

• Dr. Todd Cooper, co-director of our High Risk Leukemia Program, plays a key role in the global Pediatric Acute Leukemia (PedAL) Initiative that aims to transform treatment for children with acute leukemia. Cooper chairs the Children's Oncology Group's committees on New Agents for AML and Relapsed AML. He leads a national COG study for children with newly diagnosed AML. COG is the largest consortium in the world focused on childhood cancers.
• Dr. Soheil Meshinchi is an expert in leukemia biology, next-generation sequencing, targeted therapies for AML patients and stem cell transplants for children with leukemia. He provides scientific leadership for many national and worldwide cooperative research efforts. These include the PedAL Initiative, COG AML Biology Committee and the TARGET AML Initiative.
• Dr. Katherine Tarlock works in the Meshinchi lab to identify genetic changes in AML that can lead to new therapies. She leads 2 national COG clinical trials for targeted therapies in childhood AML. Learn more about the AML lab research at Seattle Children’s.
• Dr. Adam Lamble leads a national phase 1 clinical trial through COG that is testing a new medicine for relapsed or refractory AML. With Tarlock, he works to test a child’s leukemia cells against many different drugs, with the goal of personalizing their treatment. This is called high-throughput drug screening.

• In addition to standard diagnostics, our team uses state-of-the-art tests like molecular profiling and next-generation sequencing (NGS). We examine your child’s cancer cells for certain proteins that can serve as targets for treatment and starting points for the design of new drugs.
• These tests help us find what is different about your child’s leukemia and identify the best treatment options for them. Whenever possible, we use results from NGS to match your child with therapies that target their specific cancer. This approach is called precision (or personalized) medicine. These therapies could be medicines already approved for another disease or clinical trials of new treatments.
• In addition to targeted therapies, we offer advanced treatment options such as new mixes of anticancer medicine (chemotherapy), immunotherapy and stem cell transplants.
• For children who need stem cell transplants, we work closely with Fred Hutch, whose doctors pioneered this lifesaving treatment. Our team works with your family through the whole process — preparing for transplant, doing the transplant here at Seattle Children’s and caring for your child as they recover.

Seattle Children’s physician-scientists are known worldwide for research on the biology of childhood AML and promising new treatments. Dr. Soheil Meshinchi’s lab works to:

• Find the genetic changes that make some forms of AML harder to cure
• Develop better treatments targeted to those genetic changes
• Create more sensitive, accurate ways to monitor disease and effects of treatment

We lead research studies of new therapies, with the goal of finding cures for all children with AML. We are key players in the worldwide PedAL Initiative to identify the genetic changes that drive different forms of acute leukemia and create targeted therapies for them. We offer the very latest treatments being studied. These include phase 1 clinical trials, which many centers do not provide.

Read more about cancer research and clinical trials at Seattle Children’s.

• Our specialty is treating children’s cancer while helping them grow up to be healthy and productive adults. We take care of your child from diagnosis through all phases of treatment and follow-up survivor care.
• Our team cares for your whole child. We don’t just treat their disease. As needed, your child will receive care from specialists in nutrition, pain management, pharmacy, palliative care, physical therapy and emotional health. Read more about the supportive care we offer.
• Children do not react to illness, injury, pain and medicine in the same way as adults. They need — and deserve — care designed just for them. Our experts focus on how treatments today affect growing bodies in the future. We plan your child’s treatment based on our years of experience and the newest research on what is best and safest for children.
• We know that teens and young adults with cancer have different challenges than young children. Our Adolescent and Young Adult Cancer Program focuses on their needs, which may include fertility preservation.
• People who have been cured of cancer may be affected for months or years by their disease or treatment. Our Cancer Survivor Program provides long-term follow-up care to help children and young adults stay healthy after being treated for cancer in childhood.

• Learning that your child has leukemia can be scary. We help take positive steps right away by offering appointments in 1 to 3 days to children suspected to have cancer.
• During visits, we take time to explain your child’s condition. We help you fully understand treatment options and make the choices that are right for your family.
• Our child life specialists and social workers help your child and your family through the challenges of cancer. We connect you to community resources and support groups.
• We work with children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.