Abstract
More than 80% of children with acute lymphoblastic leukemia can now be cured. Relapses are rare after five years of remission. The most frequent sites of relapse are bone marrow, the central nervous system, and the testicles. Long-term follow-up is needed to detect late adverse effects of treatment. This includes regular cardiac examination, owing to the cumulative-dose-dependent cardiotoxicity of anthracyclines. Endocrine disorders (early puberty, growth hormone deficiency, gonad and thyroid dysfunction) are mainly due to irradiation of the brain or testicles, which is now less widely used. Growth must be monitored closely to detect early obesity. Bone mineral density can also be altered. Cognitive function, school performance and socialization are usually normal in non irradiated patients. Secondary neoplasms are rare, but some are related to previous treatments. Currently, post-cure quality of life is a major concern when choosing the treatment strategy.
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