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Published on: February 9, 2016
Late effects in survivors of infant leukemia
1Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
Insights
Long-term survivors of infant leukemia frequently experience late effects, particularly growth and learning problems. Central nervous system-directed radiation therapy (CRT) and younger age at treatment increase the risk of these complications.
Area of Science:
- Pediatric Oncology
- Hematology
- Radiation Oncology
Background:
- Late effects of infant leukemia are not well understood.
- Long-term survivors of childhood cancers face significant health challenges.
Purpose of the Study:
- To investigate the incidence and risk factors for late sequelae in infant leukemia survivors.
- To identify specific complications and their association with treatment modalities.
Main Methods:
- Retrospective evaluation of 34 infant leukemia survivors (diagnosed ≤12 months, >5 years survival).
- Comparison of late effects based on treatment groups: chemotherapy alone, chemotherapy + CNS-directed radiation therapy (CRT), and chemotherapy + CRT + bone marrow transplantation.
- Analysis of growth, learning, endocrine, and other late complications.
Main Results:
- 66% experienced growth problems, 50% learning difficulties, 15% hypothyroidism, 12% pubertal issues.
- Only 24% survived without late effects.
- Groups receiving CRT (B and C) had a higher incidence of complications, decreased height Z-scores, and academic difficulties compared to chemotherapy alone (Group A).
- Younger age at CRT increased the odds of academic difficulties.
Conclusions:
- Late sequelae are common in infant leukemia survivors.
- Central nervous system-directed radiation therapy and younger age at treatment are significant risk factors for late complications.
- These findings highlight the need for careful monitoring and potentially modified treatment strategies.
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.
