Late effects of treatments for childhood leukemia

Recovering from childhood leukemia and adjusting to life after treatment is different for each child. Recovery can depend on how far the disease progressed, the type and dose of treatment, the child’s age at the time of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with late side effects.

Your child’s healthcare team will watch for late side effects and can help prepare you for what to expect. They can also suggest ways to help your child.

Learning problems can develop in children treated with high-dose chemotherapy or intrathecal chemotherapy with methotrexate or cytarabine (Cytosar). Radiation therapy to the brain in children, especially children under the age of 5, can also cause learning and memory problems. Generally, learning problems are mild and do not cause any major disability. Children who are under the age of 5 during treatment may be at higher risk for learning problems.

Find out more about cognitive problems.

Radiation to the head and some chemotherapy drugs can cause hearing problems. Younger children are at greater risk for hearing problems.

Find out more about hearing problems.

Certain chemotherapy drugs used to treat leukemia, such as doxorubicin (Adriamycin) or daunorubicin (Cerubidine, daunomycin), can cause heart problems. These problems include abnormal heartbeat, disease of the heart muscle and congestive heart failure. Girls treated with chemotherapy have a greater risk of developing heart problems as a late effect of treatment. The healthcare team will check the heart with echocardiography during chemotherapy and as part of follow-up after chemotherapy.

Find out more about heart problems.

Treatment with certain chemotherapy drugs can cause lung problems. Inflammation of the lungs (called pneumonitis) is the most common lung problem caused by certain chemotherapy drugs, such as methotrexate.

The major concern of pneumonitis is that it can develop into pulmonary fibrosis. Pulmonary fibrosis is the formation of scar tissue in the lungs. It can cause shortness of breath and coughing and the child may find it hard to be physically active.

Find out more about lung problems.

Certain chemotherapy drugs, such as methotrexate, can cause liver problems. The liver may become larger than normal (called hepatomegaly). If the liver damage gets worse, the liver may become hard (called fibrosis) and scarred (called cirrhosis).

Find out more about liver problems.

Some chemotherapy drugs and radiation used to treat childhood leukemia can cause reproductive system problems.

In boys, radiation therapy to the brain, head or testicles can cause infertility later in life. Certain chemotherapy drugs, such as cyclophosphamide (Procytox) can also affect fertility. Treatments can also change levels of testosterone and cause delayed puberty.

In girls, certain chemotherapy drugs or radiation therapy to the brain or head can cause infertility later in life. They can also lead to delayed puberty, irregular menstruation and premature menopause. The higher the total dose of certain chemotherapy drugs, such as cyclophosphamide, the greater the risk of damage.

High doses of chemotherapy used in preparation for a stem cell transplant increase the risk of reproductive system problems in both girls and boys.

Find out more about male reproductive system problems and female reproductive system problems.

Children treated with radiation therapy to the brain may be at risk for growth hormone deficiency. If the body doesn’t have enough growth hormone, it can cause musculoskeletal problems. These problems mean the bones and muscles don’t grow as they should, which can lead to underdeveloped muscles, shorter limbs and shorter height. Children treated with radiation therapy to the brain are also at risk for osteoporosis due to low levels of sex and growth hormones.

Find out more about bone and muscle problems.

Children treated for leukemia have a risk of developing a second cancer later in life.

Radiation therapy can increase a child’s risk of developing solid tumours and leukemia later in life. Skin and central nervous system (CNS) tumours and thyroid cancers can occur after radiation therapy for leukemia.

Some chemotherapy drugs, such as cyclophosphamide and etoposide (Vepesid, VP-16), can increase the risk for a second cancer. This is especially true when these drugs are given in high doses or with radiation therapy.

One of the most serious side effects of treatment for acute lymphoblastic leukemia (ALL) is the chance of developing acute myelogenous leukemia (AML). Less than 1% of children who have received standard therapy for ALL develop AML. But children who receive certain types of more intense chemotherapy have up to a 5% chance of developing AML. More rarely, children treated for leukemia may later develop non-Hodgkin lymphoma or other cancers.

Find out more about second cancers.