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Therapy

Late effects in survivors of infant leukemia

Leukemia volume 14, pages 1185–1190 (2000)Cite this article

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 long-term survivors of infant leukemia and are often related to CRT and the patient's age at the time of CRT.

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Acknowledgements

We thank James M Boyett, PhD, for his helpful comments, Patricia Harrison for exact logistic regression analysis, the staff of the Department of Behavioral Medicine for psychological evaluations, Julia C Jones, PhD, for scientific editing, Lisa Edwards, Sherri Patterson, and Margie Zacher for data management, the physicians and staff who provide medical care, and the patients and families who completed the questionnaires and participated in this study. This work was supported in part by grants CA-20180 and CA-21765 from the National Institutes of Health, by a Center of Excellence grant from the State of Tennessee, and by the American Lebanese Syrian Associated Charities (ALSAC).

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Authors and Affiliations

  1. After Completion of Therapy Program, St Jude Children's Research Hospital, Memphis, TN, USA

    W Leung & M Hudson

  2. Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    W Leung, M Hudson, GK Rivera, RC Ribeiro, JT Sandlund, LC Bowman & C-H Pui

  3. University of Tennessee, College of Medicine, Memphis, TN, USA

    W Leung, M Hudson, GK Rivera, RC Ribeiro, JT Sandlund, LC Bowman, WE Evans & C-H Pui

  4. Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN, USA

    Y Zhu & L Kun

  5. Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA

    WE Evans & L Kun

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  1. W Leung
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Leung, W., Hudson, M., Zhu, Y. et al. Late effects in survivors of infant leukemia. Leukemia 14, 1185–1190 (2000). https://doi.org/10.1038/sj.leu.2401818

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