Late Adverse Effects after Treatment for Childhood Acute Leukemia


  • Jelena Roganovic Department of Pediatric Hematology and Oncology, Children’s Hospital Zagreb, Zagreb, Croatia; Faculty of Biotechnology and Drug Development, University of Rijeka, Rijeka, Croatia
  • Riccardo Haupt Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
  • Edit Bárdi St. Anna Childrens Hospital, Wien; Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria
  • Lars Hjorth Department of Pediatrics, Skane University Hospital; Department of Clinical Sciences, Lund University, Lund, Sweden
  • Gisela Michel Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
  • Vesna Pavasovic Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
  • Katrin Scheinemann Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Division of Hematology-Oncology, Children’s Hospital of Eastern Switzerland, St Gallen, Switzerland; Department of Pediatrics, McMaster Children’s Hospital and McMaster University, Hamilton, Canada
  • Helena J.H. van der Pal Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
  • Lorna Zadravec Zaletel Radiotherapy Department, Institute of Oncology Ljubljana, Ljubljana; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
  • Ana E. Amariutei Youth Cancer Europe, Cluj-Napoca, Romania
  • Roderick Skinner Department of Paediatric and Adolescent Haematology and Oncology, Great North Children’s Hospital, Royal Victoria Infirmary; Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom
  • PanCare Board



Child, Acute Leukemia, Late Effects, Survivor, Long-Term Follow-Up


The aim of this review is to raise awareness and knowledge among healthcare professionals and policymakers about late adverse effects in survivors of childhood leukemia. With contemporary treatment, over 90% of children with acute lymphoblastic leukemia (ALL) and over 60% with acute myeloid leukemia (AML) are cured. Large cohort studies demonstrate that 20% of ALL and most AML survivors have at least one chronic health condition by 20-25 years after diagnosis. These are life-changing or threatening in some survivors and contribute to increased premature mortality. We describe the frequency, causes, clinical features, and natural history of the most frequent and severe late adverse effects in childhood leukemia survivors, including subsequent malignant neoplasms, metabolic toxicity, gonadotoxicity and impaired fertility, endocrinopathy and growth disturbances, bone toxicity, central and peripheral neurotoxicity, cardiotoxicity, psychosocial late effects, accelerated ageing and late mortality. The wide range of late effects in survivors of haemopoietic stem cell transplant is highlighted. Recent developments informing the approach to long-term survivorship care are discussed, including electronic personalized patient-specific treatment summaries and care plans such as the Survivor Passport (SurPass), surveillance guidelines and models of care. The importance of ongoing vigilance is stressed given the increasing use of novel targeted drugs with limited experience of long-term outcomes.

Conclusion. It is vital to raise awareness of the existence and severity of late effects of childhood leukemia therapy among parents, patients, health professionals, and policymakers. Structured long-term surveillance recommendations are necessary to standardize follow-up care.


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How to Cite

Roganovic, J., Haupt, R., Bárdi, E., Hjorth, L., Michel, G., Pavasovic, V., Scheinemann, K., van der Pal, H. J., Zadravec Zaletel, L., Amariutei, A. E., Skinner, R., & Board, P. (2024). Late Adverse Effects after Treatment for Childhood Acute Leukemia. Acta Medica Academica.



Clinical Medicine