eMedicine Specialties > Pediatrics: General Medicine > Oncology

Acute Lymphoblastic Leukemia: Follow-up

Author: Noriko Satake, MD, Assistant Professor, Department of Pediatrics, Section of Hematology/Oncology, University of California Davis School of Medicine, Davis Medical Center
Coauthor(s): Janet M Yoon, MD, Assistant Clinical Professor, Department of Pediatrics, Hematology/Oncology, University of California Davis Medical Center
Contributor Information and Disclosures

Updated: Aug 12, 2009

Follow-up

Further Inpatient Care

  • Frequent hospitalizations may be required to deal with complications of acute lymphoblastic leukemia (ALL) therapy, including the need for blood transfusions or antibiotics.
  • Immediately admit any patient who is neutropenic and who develops chills or fever to administer intravenous (IV) broad-spectrum antibiotics.

Further Outpatient Care

  • Frequent clinic visits are required to administer outpatient chemotherapy, to monitor blood counts, and to evaluate new symptoms.

Inpatient & Outpatient Medications

  • Pneumocystis prophylaxis: All patients should be on TMP-SMZ to prevent Pneumocystis carinii pneumonia (PCP).
  • Fungal prophylaxis: Patients may benefit from receiving oral nystatin or clotrimazole (Mycelex) troches to reduce the risk of candidiasis. Patients with a high risk of relapse may also need additional anti-fungal therapy such as itraconazole.
  • Mouth care: Patients should swish and spit with an antimicrobial, such as chlorhexidine (Peridex) or antibacterial enzymatic mouthwash (Biotene), 4 times a day.

Transfer

  • Initially transfer patients to a facility in which they can be in the care of a pediatric oncologist, preferably a center that participates in multi-institutional clinical trials.

Deterrence/Prevention

  • Because the cause of acute lymphoblastic leukemia is unknown, no method of prevention is known.

Complications

  • Complications of leukemia and its therapy include the following:
    • Tumor lysis syndrome
    • Renal failure
    • Sepsis
    • Bleeding
    • Thrombosis
    • Typhlitis
    • Neuropathy
    • Encephalopathy
    • Seizures
    • Secondary malignancy
    • Short stature (if craniospinal radiation)
    • Growth hormone deficiency
    • Cognitive defects

Prognosis

  • Overall, the cure rate for childhood acute lymphoblastic leukemia is more than 80%. However, the prognosis depends on the clinical and laboratory features described above.
  • In general, the prognosis is best in children aged 1-10 years.
  • Adolescents have intermediate outcomes.
  • Infants younger than 1 year have a poor outcome, with cure rates of about 30%.
  • Survivors may experience late effects from treatment, which involve all organ systems.  Therefore, lifelong follow-up is necessary.7

Patient Education

  • Ensure that the patient's parents and guardians have a reasonable understanding of the expected adverse effects of each medication.
  • In addition, parents and guardians must be able to recognize signs and symptoms that require medical attention, such as signs and symptoms of anemia, thrombocytopenia, and especially infection.
  • Parents must know how to quickly access medical help from the oncology team.
  • For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education article Leukemia.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize signs and symptoms of acute lymphoblastic leukemia (ALL) can lead to delays in treatment.
  • Acute lymphoblastic leukemia is a life-threatening disease, and delays in diagnosis can lead to death.
 


More on Acute Lymphoblastic Leukemia

Overview: Acute Lymphoblastic Leukemia
Differential Diagnoses & Workup: Acute Lymphoblastic Leukemia
Treatment & Medication: Acute Lymphoblastic Leukemia
Follow-up: Acute Lymphoblastic Leukemia
Multimedia: Acute Lymphoblastic Leukemia
References
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References

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Further Reading

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Keywords

acute lymphocytic leukemia, acute lymphatic leukemia, acute lymphoid leukemia, ALL, pediatric cancer, childhood cancer, childhood malignancy, inherited genetic syndromes, lymphoblastic leukemia, leukemia, leukemic blasts, T cell, T-cell ALL, B cell, B-lineage ALL, BCR-ABL, MLL, high-risk ALL, exposure to ionizing radiation, exposure to electromagnetic fields, allogeneic hematopoietic stem cell transplantation, HSCT, bone marrow failure, anemia, thrombocytopenia, neutropenia, petechiae, bleeding, lymphadenopathy, hepatosplenomegaly, bone pain, Down syndrome, Fanconi anemia, Bloom syndrome, influenza, varicella, Wiskott-Aldrich syndrome, congenitalhypogammaglobulinemia, ataxia-telangiectasia

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Contributor Information and Disclosures

Author

Noriko Satake, MD, Assistant Professor, Department of Pediatrics, Section of Hematology/Oncology, University of California Davis School of Medicine, Davis Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Janet M Yoon, MD, Assistant Clinical Professor, Department of Pediatrics, Hematology/Oncology, University of California Davis Medical Center
Janet M Yoon, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology and Children's Oncology Group
Disclosure: Nothing to disclose.

Medical Editor

Stephan A Grupp, MD, PhD, Director, Stem Cell Biology Program, Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia; Associate Professor of Pediatrics, University of Pennsylvania
Stephan A Grupp, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Timothy P Cripe, MD, PhD, Professor of Pediatric Hematology/Oncology, University of Cincinnati; Director, Translational Research Trials Office, Department of Pediatrics, Cincinnati Children's Hospital Medical Center
Timothy P Cripe, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Samuel Gross, MD, Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University
Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD, King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine
Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

 
 
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