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.