Intrathecal Chemotherapy All children with AML are treated with intrathecal chemotherapy , which is chemotherapy given directly into the spinal fluid by performing a lumbar puncture (spinal tap) and slowly injecting the drug into the spinal fluid. Most children require sedation to remain still during lumbar punctures. Even if no leukemia cells are detected in the spinal fluid, intrathecal chemotherapy is given at specific intervals during treatment to prevent the leukemia cells from spreading to the spinal fluid. For children with AML cells in their cerebrospinal fluid at diagnosis, intrathecal chemotherapy is given more frequently to treat the leukemia. Monoclonal Antibody Therapy Monoclonal antibodies are a new class of drugs for the treatment of AML. They have shown promising results in adult studies and in preliminary children’s studies. These antibodies are used to deliver drugs and toxins to cancer cells. For patients with AML, the antibody attaches to a protein found on the surface of many AML cells. This class of drugs is sometimes referred to as “magic bullets.” These drugs target and deliver most of the chemotherapy to the leukemia cells, sparing the normal healthy cells from the effects of treatment. Currently, these drugs are used in combination with chemotherapy to improve the long-term survival of children with AML. Hematopoietic Stem Cell Transplant Children who have been diagnosed with high-risk AML and have a sibling with the same human leukocyte antigen (HLA) tissue type may receive a hematopoietic stem cell transplant (HSCT) following induction chemo- therapy. High-risk AML is defined as AML that does not achieve remission after induction chemotherapy, has high-risk cytogenetic features, or has relapsed. HLA type refers to the unique set of proteins present on the surface of the WBCs. There is a 25% chance that two full sib- lings will share the same HLA type. All children who are to receive HSCT must have HLA typing completed to determine the most suitable donor. HLA typing is a test to determine how closely the tissue of one person matches the tissue of another person. The tissue type is obtained either through a blood test or by swabbing the inside of the mouth. The healthcare team may decide to perform HLA typing on a child with AML, their parents, and any full siblings soon after diagnosis. For patients who require a transplant and do not have a suitable sibling match, the health - care team may decide to search for unrelated donors through a registry such as the National Marrow Donor Program. All patients who undergo HSCT will first receive intensive chemotherapy to achieve remission.
n WHAT ARE THE SIDE EFFECTS OF TREATMENT?
Chemotherapy In addition to killing AML cells, cancer chemotherapy also damages normal tissue and causes side effects. Side effects from chemotherapy often begin soon after chemotherapy is initiated and continue for 2–4 weeks. Common side effects include nausea, vomiting, hair loss, fatigue, and diarrhea; these can occur regardless of the route of chemotherapy administration (oral, IV, or intrathecal). The most common serious side effect from chemotherapy is a drop in
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