Long-term effects of cancer treatment of childhood leukemia

Because of major advances in treatment, more children treated for cancer (including leukemia) are now living into adulthood. With childhood cancer survivors living longer, their health as they get older has come more into focus in recent years.

Just as the treatment of childhood cancer requires a very specialized approach, so does follow-up and monitoring for late effects of treatment. Careful follow-up after cancer treatment is very important.

Childhood leukemia survivors are at risk, to some degree, for several possible late effects of their cancer treatment. This risk depends on a number of factors, such as the type of leukemia, the type of treatments they received, dosages of cancer treatment, and age at the time of treatment.

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 they have received 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 with chemotherapy.

Late effects may also include heart or lung problems after receiving certain chemotherapy drugs or radiation therapy to these parts of the body. The risks of heart disease and stroke later in life 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.

Treatment that includes radiation therapy to the brain may affect learning ability in some children, as might some types of chemotherapy. Because of this, doctors try to limit treatments that could affect the brain (including radiation) as much as possible.

Survivors of childhood leukemia often suffer from emotional or psychological problems. They also may have some problems with normal functioning and schoolwork. These can often be helped with support and encouragement.

Some cancer treatments may affect a child's growth, and they may end up a bit shorter as adults. This is especially true after stem cell transplants. This can be helped by the treating survivors with growth hormone, if needed.

Cancer treatment may also affect sexual development and ability to have children in some cases.

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.

Long-term follow-up guidelines

To help increase awareness of late effects and improve follow-up care of 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 type of screening should be done, and how late effects may be treated.

It is 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 download them for free at the CureSearch Web site: www.survivorshipguidelines.org. The guidelines are written for health care professionals. Patient versions of some of the guidelines available (as "Health Links") on the site as well, but we urge you to review them with a doctor.

For more about some of the possible long-term effects of treatment, see our document, Children Diagnosed With Cancer: Late Effects of Cancer Treatment.