They account for about 10 % of leukemias in childhood.

Classification:

• AML with recurrent cytogenetic abnormalities

-        with t(8;21)(q22;q 22) RUNX1-RUNX1T1

-        with inv(16)(p 13.1;q 22) or t (16;16) CBFB-MYH11

-        promyelocytic AL with t(15;17)(q22;q12) PML-RAR

-        with t(9;11)(p 22;q23) MLL T3-ML

-        with t(6;9)(p23;q34) DEK-NUP214

-        with inv(3)(q21q26.2) or t (3;3)(q21;q26.2) RPN1-EVI1

-        Megakaryoblastic AML with t (1;22)(p13;q13) RBM15-MKL1

-        AML with mutated NPM1

-        AML with transferred CEPBa

• AML with myelodysplastic syndrome

• secondary myeloid dysplasias (AML and MDS): following chemotherapy and or radiotherapy

• AML without any other peculiarity

-        AML with minimal differentiation

-        AML without maturation

-        AML with maturation

-        myelomonocytic AL (see this term)

-        monoblastic or monocytic AL

-        erythroblastic AL

-        megakaryoblastic AL (see neonatal and small infant leukemias)

-        AL with basophiles

-        acute panmyelosis with myelofibrosis

• myeloid sarcoma: localized "solid" form

• myeloid proliferations associated with Down syndrome (trisomy 21)

• neoplasias of the plasmocytoid dendritic cells

The main clinical manifestations are similar to those of acute lymphoblastic leukemias as they are the result of medullary involvement by a single blast cell line, inhibiting the normal cell lines. However, there are symptoms that are unusual in ALL such as subcutaneous nodules ("blueberry muffins"), gingival infiltrations, signs of DIVC   and various masses, including in the orbits and the epidural space, called chloromas or granulocytic sarcoma.

The diagnosis is based on the same examinations as ALL's, in order to identify the cell subtype involved. Treatment is based on the combination of several chemotherapic drugs. It is particularly aggressive and 10 % of the patients die of infection or hemorrhage before the first remission. The 5-year survival rate is in the range of 60-70 %. Children with acute myelocytic leukemia have a high risk of graft-host disease after bone marrow transplantation, which is rare in the case of ALL's.

Schematically, the therapeutic management of myelocytic leukemia is similar to that of ALL, with the difference that chemotherapy is more aggressive and leads to longer-lasting bone marrow aplasia, exposing the patients to a much higher risk of infection.

Anesthetic implications: 

see acute lymphoblastic leukemias

References : 

-        ter Bals E, Kaspers GJ.
Treatment of childhood acute myeloid leukemia.
Expert Rev Anticancer Ther 2005; 5:917-29.

-        Creutzig U, Zimmermann M, Dworzak M, Urban C, Henze G, Kremens B, Lakomek M, Bourquin JP, Stary J, Reinhardt D.
Favourable outcome of patients with childhood acute promyelocytic leukaemia after treatment with reduced cumulative anthracycline doses.
Br J Haematol 2010; 149:399-409.

Updated: March 2021