Long-term effects of treatment for childhood leukemia

Because of major advances in treatment, more children treated for cancer are 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 special approach, so does follow-up and watching for late effects. 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 treatments given, doses of cancer treatment, and age at time of treatment.

Children who have been treated for leukemia are at higher risk of getting other cancers later in life. One of the most serious side effects of treatment for acute lymphocytic leukemia (ALL) is the small chance of getting acute myelogenous leukemia (AML) at a later time. This happens in about 5% of treated patients after they have had certain types of chemotherapy (chemo) drugs. Of course, the risk of getting these second cancers must be balanced against the clear value of treating a life-threatening disease like leukemia with chemo.

Late effects may also include heart or lung problems after getting certain chemo drugs or radiation 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.

Children whose treatment for leukemia has included radiation therapy of the brain may have some decrease in their learning ability Doctors try to limit radiation to the brain whenever they can.

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

Some 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 the ability to have children in some cases.

Bone damage or thinning of the bones (osteoporosis) may result from the use of some steroid drugs.

There may be other possible problems from treatment that your child's doctor should carefully review with you before starting treatment. Special centers are often the best places for children to be treated when such effects happen.

To help improve follow-up care of childhood cancer survivors throughout their lives, the Children's Oncology Group (COG) has written long-term follow-up guidelines for doctors. These guidelines describe in detail the suggested long-term follow-up care based on the treatments the child has received. To learn more, ask your child's doctors about the COG survivor guidelines. You can also download them for free at the COG 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.

To learn more about possible late effects of treatment, please see our document, Children Diagnosed With Cancer: Late Effects of Cancer Treatment.