Late and Long-term Effects of Treatment of Childhood Leukemia
Because of major advances in treatment, most children treated for leukemia are now living into adulthood, so their health as they get older has come more into focus in recent years.
Just as the treatment of childhood leukemia requires a very specialized approach, so does the care and follow-up after treatment. The earlier problems are recognized, the more likely it is they can be treated effectively.
Childhood leukemia survivors are at risk, to some degree, for several possible late effects of their treatment. This risk depends on a number of factors, such as the type of leukemia, the type and doses of treatments they received, and the age of the child at the time of treatment. It’s important to discuss what these possible effects might be with your child’s medical team so you know what to watch for and report to the doctor.
Second cancers: Children who have been treated for leukemia are at higher risk of developing other cancers later in life. One of the most serious possible side effects of acute lymphocytic leukemia (ALL) therapy is a small risk of getting acute myelogenous leukemia (AML) later on. This occurs in about 5% of patients after getting chemotherapy drugs called epipodophyllotoxins (etoposide, teniposide) or alkylating agents (cyclophosphamide, chlorambucil). Of course, the risk of getting these second cancers must be balanced against the obvious benefit of treating a life-threatening disease such as leukemia.
Heart and lung problems: Certain chemotherapy drugs or radiation therapy to the chest can sometimes cause heart or lung problems later in life. The risks of heart disease and stroke are much higher among those treated for ALL as children, so careful follow-up is very important. ALL survivors are also more likely to be overweight and to have high blood pressure, which can contribute to these problems.
Learning problems: Treatment that includes radiation therapy to the brain or some types of chemotherapy may affect learning ability in some children. Because of this, doctors try to limit treatments that could affect the brain (including radiation) as much as possible.
Growth and development: Some cancer treatments may affect a child’s growth, so they may end up a bit shorter as adults. This is especially true after stem cell transplants. This can be helped by treating survivors with growth hormone, if needed.
Fertility issues: Cancer treatment may also affect sexual development and ability to have children later in life. Talk to your child’s cancer care team about the risks of infertility with treatment, and ask if there are options for preserving fertility, such as sperm banking. For more information, see Fertility and Women With Cancer and Fertility and Men With Cancer.
Bone problems: Bone damage or osteoporosis (thinning of the bones) may result from the use of prednisone, dexamethasone, or other steroid drugs.
There may be other possible complications from chemotherapy as well. Your child’s doctor should carefully review any possible problems with you before your child starts treatment.
Along with physical side effects, some childhood leukemia survivors might have emotional or psychological issues. They might also have problems with normal functioning and school work. These can often be addressed with support and encouragement. If needed, doctors and other members of the health care team can recommend special support programs and services to help children after cancer treatment.
Long-term follow-up guidelines
To help increase awareness of late effects and improve follow-up care for childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what types of screening tests should be done, and how late effects can be treated.
It’s very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child’s doctors about the COG survivor guidelines. You can also read them on the COG website: www.survivorshipguidelines.org. The guidelines are written for health care professionals. Patient versions of some of the guidelines are available (as “Health Links”) on the site as well, but we urge you to discuss them with your doctor.
For more about some of the possible long-term effects of treatment, see Children Diagnosed With Cancer: Late Effects of Cancer Treatment.
Last Medical Review: April 17, 2015 Last Revised: February 3, 2016