Long term survivors of childhood leukemia

Changes in therapy, primarily intensification, for childhood leukemias have significantly improved cure rates during the past 30 years. The increasing number of survivors has led to a heightened appreciation of the late compl ications of treatment caused by both radiation and chemotherapy, Important late effects include decreased growth, poor school performance, altered car diac function, infertility, and second malignant neoplasms. The long term o utcome of children and adolescents suffering from the most recently recogni zed acute complication of treatment, avascular necrosis of weightbearing bo nes, is still not known. These, and all patients treated on clinical trials , should be followed throughout their lives, Many of the complications of t reatment are often not realized until years after the completion of therapy ; some have been found to be related to dose intensity, emphasizing the imp ortance of clinical trials that examine reduction of therapy for diseases w ith excellent cure rates, A successful example of this strategy is the elim ination or reduction of radiation dose for the prevention of central nervou s system acute lymphocytic leukemia. This has resulted in fewer long term c entral nervous system complications without a decrease in survival rates, A s knowledge of late effects increases, design of future trials will need to focus on striking a balance between cure and long term toxicity, (C) 2000 Lippincott Williams & Wilkins, Inc.