or spinal cord, causing pressure symptoms and mimicking non-haemic solid tumours. They are more common in AML with t(8;21). Peri-orbital chloromas are also not unusual in infants with M4/M5 AML.

Treatment and outlook

Outcome of therapy for childhood AML has shown a dramatic improvement over the last 15 years. From a dismal outlook in the 1970s through around 30% EFS in the 1980s we have now achieved >50% EFS at the turn of the 21st century. This has been due to increasingly intensive chemotherapy and parallel improvements in supportive treatment for the secondary marrow failure it produces.

The principle of treatment is to ablate marrow with chemotherapy to the point that endogenous recovery occurs within 4-6 weeks and to repeat the process with different drug combinations 4 or 5 times, giving a total treatment time of around 6 months. Results using this approach have improved for children in the best risk groups to the point where allo-geneic BMT is no longer considered the consolidation treatment of choice even if a matched donor is available.

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