Late and long-term effects of treatment for childhood leukemia
Because of major advances in treatment, most children treated for leukemia are 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 special approach, so does follow-up and watching for late effects. The earlier the problems are found, 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 treatments given, doses of cancer treatment, and age at 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.
Children who have been treated for leukemia have a 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) later. 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. For more on second cancers, see our document Second Cancers Caused by Cancer Treatment.
Late effects can 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.
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 treating survivors with growth hormone, if needed.
Cancer treatment might also affect sexual development and the ability to have children. Talk to your child’s cancer care team about these risks, and ask if there are options for preserving fertility, such as sperm banking. For more, see our document Fertility and Cancer: What Are My Options?
Bone damage or thinning of the bones (osteoporosis) can 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.
Long-term follow-up guidelines
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.
It’s very important to discuss possible long-term health effects 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 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 a doctor.
To learn more about possible late effects of treatment, see our document Children Diagnosed With Cancer: Late Effects of Cancer Treatment.
Last Medical Review: 11/11/2013
Last Revised: 02/03/2014