Although this NEJM review focuses on survivors of ALL some general principles apply. This is of peripheral interest to hospitalists. The review is free full text, at least for now.
Points of interest:
The care of these patients requires special expertise. Pediatric oncologists provide this service and there are “survivor clinics.” (See this link).
In addition to an increased risk of solid tumors survivors of ALL, though at virtually no risk of recurrence of ALL, are at increased risk for late post treatment myelodysplasia and AML. The degree of this risk depends on the original agents used.
Patients have an increased risk of obesity and metabolic syndrome. This may relate to dysfunction in the GH axis in those who received cranial irradiation.
Those given anthracyclines have an increased risk of heart failure that increases over time, even when lower doses were used.
More about the article from the NEJM blog.
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