Late effects in children receiving total body irradiation for bone marrow transplantation

Bone marrow transplantation is a life-saving procedure for an increasing number of children and young adults. As greater number of patients continue to receive this procedure and are cured of their underlying hematologic disorder, greater attention must be given to the delayed effects, especially those which do not appear until years after the transplant procedure. Children who are cured of their underlying disease continue to visit the hematologist/oncologist, but with decreasing frequency as time increases following the curative therapy, and at the same time increase the relative frequency of visits to their pediatrician. Thus, it is imperative that the primary care pediatrician be aware of the details of the patient's previous medical history, especially of chemotherapy and irradiation therapy which may have been given, in order to anticipate the delayed effects. Early diagnosis of thyroid and GH deficiencies with institution of appropriate hormone therapy may prevent subsequent development of thyroid malignancy and may improve the child's growth and development. Recognition of cataracts and dry eye syndrome is necessary to prevent visual difficulties. Careful oral examination and attention to the child's general neurological presentation and inquiry regarding school performance is important in recognising dental difficulties, learning difficulties and early recognition of development of tumors of the head and neck. Attention to details, early recognition of problems and early therapy of the problems is needed to improve the quality of life for these unique patients.