Acute therapy-related toxicities in pediatric acute lymphoblastic leukemia

Most children diagnosed with acute lymphoblastic leukemia (ALL) will achieve remission and be cured of their disease. However, this high cure rate comes at the cost of acute and chronic treatment-related toxicities. In fact, of those who do not survive, a similar number of children die from either ALL itself or the toxicities associated with its treatment. Therapy- related toxicities, whether acute or chronic, can impact treatment efficacy, overall survival (OS), and the patient's quality of life. This review focused on six major acute toxicities of ALL therapy, venous thromboembolism, osteonecrosis, neurological sequelae, delayed methotrexate (MTX) elimination, asparaginase-associated pancreatitis, and toxicities resulting from the new biological therapies. Most of these severe acute toxicities of ALL treatment can be mitigated through tailored therapy adaptations for individual patients and careful incorporation of immunotherapy. These adaptations will soon become a central component of contemporary pediatric ALL protocols and ultimately improve patients' OS and wellness.