#Leukemia #ALL #AML #LongTermFollowUp #Oncology #Cancer
Thanks to advances in
pediatric oncology, the
vast majority of children
with acute leukemia are now cured. More than
90% of patients with acute
lymphoblastic leukemia (ALL) and about
60 to 70% of children with acute myeloid
leukemia (AML) survive thanks to progress in
chemotherapy, immunotherapy, and
stem cell transplantation.
However, these aggressive treatments lead to
late side effects that can
impact
survivors’ quality of life. Around
20% of former ALL patients and
the
majority of AML survivors develop
a chronic illness within 20 to 25 years of
diagnosis. These complications often affect the
heart, metabolism, bones, or
nervous system, increasing the risk of
premature mortality.
Although these side effects are well-documented, they are sometimes
underestimated. It is therefore crucial to ensure
regular, personalized medical
follow-up to detect and manage these complications early.
This study explores
the
long-term impact of childhood leukemia treatments and the importance of
structured follow-up to improve survivor care.
Read next: ALL: a constantly evolving battle
Cure—at what cost?
This study is based on
cohort analyses of pediatric leukemia survivors
to identify
late adverse effects of treatments. The studied complications
include:
- Metabolic
toxicity: metabolic
syndrome, obesity, diabetes.
- Gonadotoxicity
and infertility:
fertility disorders caused by chemotherapy and radiotherapy.
- Endocrine
disorders: impaired
growth hormones and thyroid dysfunctions.
- Bone
damage: osteoporosis,
osteonecrosis due to corticosteroids.
- Neurotoxicity: damage to the central and peripheral
nervous systems affecting cognitive and motor functions.
- Cardiotoxicity: heart failure, hypertension linked to
anthracyclines.
- Psychosocial
consequences: anxiety,
depression, social integration difficulties.
- Premature
aging: acceleration of
cellular degeneration processes, increased late mortality.
Leukemia survivors are at
high risk of chronic complications. On
average, a patient treated for
ALL develops between 4 and 16 chronic conditions
over the
50 years following recovery, while those who had
AML develop between 7
and 19.
Cardiovascular and endocrine diseases are among the most common
complications, requiring long-term follow-up. Additionally, many survivors
experience
neurocognitive disorders, particularly after
radiotherapy or certain
chemotherapies, affecting
memory, concentration, and learning. These findings
highlight the importance of
tailored care and structured medical follow-up to
minimize long-term sequelae.
Read next: Sepsis and memory: a link not to be forgotten!
Surviving, but Under Surveillance!
Thanks to advances in pediatric oncology,
ALL and
AML have become
largely curable. However, the intensive treatments required for recovery expose
survivors to
late side effects, sometimes debilitating, which can affect their
long-term quality of life.
This study aims to analyze
the impact of pediatric leukemia treatments
on long-term health and to highlight the importance of
appropriate medical
follow-up to prevent and manage late side effects.
Early identification of late complications is crucial to ensuring a
better quality of life for survivors. A structured follow-up, based on
international guidelines such as the Survivor Passport, allows long-term
care to be tailored, complications to be better anticipated, and patient
management to be improved.
Despite advances in understanding late side effects, major challenges
remain.
Access to medical follow-up for leukemia survivors remains unequal, and
the long-term effects of newer treatments, such as
targeted therapies and
immunotherapies, are still poorly understood. The future of follow-up care lies
in
personalized approaches, combining
tailored surveillance,
early management
of complications, and
preventive strategies. Improving access to post-cancer
care and developing
less toxic treatments will be essential to ensuring a
better quality of life for recovered patients.
Read next: IVIG: an ally against fever in ALL?
