Long-term outcomes in survivors of childhood acute lymphoblastic leukemia

Cure rates for childhood acute lymphoblastic leukemia (ALL) now exceed 80%. Consequently, there is a growing population of survivors of childhood ALL who are at risk for developing late sequelae of their cancer therapy. The risk of developing a late effect of therapy is particularly high in those survivors treated with cranial radiation or hematopoietic stem cell transplantation; however, most children who survive after treatment in the current era are expected to live normal lives with minimal or no longterm morbidity. In this article, the more common, serious late effects of ALL therapy are reviewed, the treatment exposures that predispose some survivors to their development are discussed, and the need for life-long risk-based medical care for all survivors of childhood ALL is emphasized.