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Acute myeloid leukemia in children and adolescents

Katherine Tarlock, MD
Todd M Cooper, DO
Section Editor
Julie R Park, MD
Deputy Editor
Alan G Rosmarin, MD


Acute leukemia accounts for approximately 30 percent of all childhood malignancies and is the most common cancer in children. Acute myeloid leukemia (AML) accounts for approximately 15 percent of childhood leukemia and is much less common in the pediatric population than acute lymphoblastic leukemia (ALL), which accounts for 80 percent of pediatric acute leukemia. Survival rates for AML have greatly improved over the past several decades; however, overall survival for children with AML is approximately 65 to 70 percent and remains lower than for children with ALL [1]. The improvements in survival have been achieved through clinical trials investigating the role of intensification of therapy, including the use of allogeneic hematopoietic cell transplantation (HCT), as well as improvements in supportive care.

This topic will provide an overview of AML in children and adolescents, focusing on issues that are of interest to primary care providers. The pathogenesis of AML and discussions of the molecular genetics and cytogenetics in AML are presented separately. Transient myeloproliferative disorder of Down syndrome is also discussed separately. (See "Pathogenesis of acute myeloid leukemia" and "Molecular genetics of acute myeloid leukemia" and "Cytogenetics in acute myeloid leukemia" and "Transient myeloproliferative disorder of Down syndrome".)


Clinical presentation — The most common presenting symptoms of AML are reflective of the leukemic burden. Similar to those with acute lymphoblastic leukemia (ALL), patients with AML can present with fever, malaise, musculoskeletal pains, lymphadenopathy, hepatosplenomegaly, and bleeding. A complete blood count most often reveals anemia and thrombocytopenia and can have decreased, normal, or increased white blood cell (WBC) counts with leukemic myeloblasts noted on the peripheral smear. The less common complications described below may require immediate medical intervention.

Disseminated intravascular coagulation (DIC) can be present and can range from mild to severe, especially in some subtypes of AML (eg, acute promyelocytic leukemia). Complications due to the leukemic burden at diagnosis may also include an elevated WBC of >100,000/microL, leading to leukostasis. (See 'Supportive care' below and 'Acute promyelocytic leukemia' below and "Clinical assessment of the child with suspected cancer".)

Less often, children may present with symptoms of central nervous system (CNS) involvement (eg, headache, lethargy, mental status changes, cranial nerve palsies) or other extramedullary sites. Significant electrolyte derangements and acute kidney injury can occur, especially in those with high WBC or tumor burden. Hepatic dysfunction can also be present at diagnosis. (See 'Supportive care' below.)

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Literature review current through: Dec 2017. | This topic last updated: Aug 08, 2017.
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