Late effects in survivors of infant leukemia

Abstract

Little is known about the incidence of and risk factor for late effects of infant leukemia. We evaluated 19 children with acute lymphoblastic leukemia and 15 with acute myeloid leukemia who were diagnosed at age 12 months or younger and have survived for more than 5 years after the diagnosis (median length of follow-up, 13 years; range, 5.7-29 years). Ten patients received chemotherapy alone (group A), 17 received chemotherapy and CNS-directed radiation therapy (CRT) (group B), and seven received chemotherapy, CRT and bone marrow transplantation (group C). The most frequently observed late sequelae included problems in growth (66% of survivors), learning (50%), hypothyroidism (15%), and pubertal development (12%). Cataract, cardiac and hearing abnormalities occurred in 6% of patients. Only eight patients (24%) survive without late effects. In comparison to patients in group A, patients in groups B and C had a higher incidence of having at least one late complication (P = 0.009), a greater decrease in height Z score at 5 years after diagnosis (P = 0.023), and a higher incidence of academic difficulties (P = 0.004). The estimated odds of academic difficulties increased by 18% (P = 0.032) for each month younger in age at the time of CRT. These results indicate that late sequelae are common in longterm survivors of infant leukemia and are often related to CRT and the patient's age at the time of CRT. Leukemia (2000) 14, 1185-1190.

Allogeneic bone marrow transplantation for infants with acute leukemia or myelodysplastic syndrome

“…31 Very few studies have focused on the effects of BMT and irradiation in the rare population of survivors of infant leukemia. 5,11,32 We have previously described the late effects in a relatively large cohort of 34 patients who survived for more than 5 years after the diagnosis of infant leukemia. 11 Growth and neurocognitive problems were more common in the group who received BMT and irradiation than in the group who received chemotherapy alone.…”

“…5,11,32 We have previously described the late effects in a relatively large cohort of 34 patients who survived for more than 5 years after the diagnosis of infant leukemia. 11 Growth and neurocognitive problems were more common in the group who received BMT and irradiation than in the group who received chemotherapy alone. However, it has not been determined whether late sequelae of BMT are more common and more severe in infants than in older pediatric patients who received similar transplants.…”

“…11,13 Briefly, after completion of therapy, remission and immune status and late effects of treatment are comprehensively assessed at least annually in our BMT annual follow-up clinic. During each clinic visit, patients or parents complete a four-page questionnaire eliciting information such as medical status and academic progress.…”

“…Such factors include the biology of the disease, [7][8][9] maturity of organ systems, disposition of antineoplastic agents, 10 and susceptibility of the patient to late sequelae. 11 Because very few infants have undergone allogeneic BMT, little information exists about their outcomes. Here we report the treatment sequelae and prognostic factors of 22 infants with acute leukemia or MDS who received allogeneic BMT at the age of 24 months or younger.…”

Second malignancy after treatment of childhood acute myeloid leukemia

“…10,11 Details of the clinical characteristics and treatment histories of the patients in whom a second malignancy developed were obtained from the medical records. All pathologic materials of the second malignancy were reviewed and classified by our pathologists.…”