Primary Care after Childhood Leukemia

Posted by Graham McMahon • October 14th, 2011

The latest article in our Clinical Practice series provides guidance for care of adult survivors of childhood acute lymphoblastic leukemia, the most common childhood cancer. Treatments are associated with increased late risks of several other conditions; surveillance and patient education strategies are reviewed.

There are (as of 2006) an estimated 50,000 survivors of childhood leukemia in the US, over half of whom are age 20 or older.

Clinical Pearls

What tumors are associated with radiation treatment?

Postradiation tumors include brain tumors, parotid gland tumors, thyroid cancers, basal and squamous cell carcinomas, and soft tissue and bone sarcomas.

What cardiac problems occur among survivors of childhood leukemia?

Guidelines recommend that persons treated with anthracyclines in childhood have a baseline echocardiogram at entry into long-term follow-up and at 3 to 5 year intervals, with shorter interval for patients who received higher doses (greater than or equal to 250 to 300 mg/m2), received chest radiotherapy, or had a history of acute cardiotoxicity during childhood treatment.

Table 1. Major Long-Term Risks of Disease among Adult Survivors of Childhood Acute Lymphoblastic Leukemia.

Morning Report Questions

Q: What are the endocrine problems that occur among survivors of childhood leukemia?

A: Studies of leukemia survivors also demonstrate an increased prevalence, compared with control populations, of components of the metabolic syndrome, including high BMI, truncal obesity, insulin resistance, hypertension and dyslipidemia. Childhood leukemia survivors demonstrate attenuated bone mineral accretion, which may result in an increased incidence of osteopenia, early onset osteopenia, or both. Growth hormone deficiency is the most common neuroendocrine complication after leukemia therapy and is associated, in a dose-dependent fashion, with exposure to cranial radiation.

Q: What neurocognitive and developmental problems occur among survivors of childhood leukemia?

A: Children treated for cancer at young ages may not experience “normal” development; health limitations during childhood might have prevented regular school attendance and achievement of normal developmental milestones. Childhood leukemia survivors are less likely than their siblings to graduate from college, to be fully employed, or to obtain health insurance.

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