Your child takes many medicines while being treated for acute myeloid leukemia (AML). Although they do a good job of killing leukemic cells, they can affect normal cells as well. Damage to healthy cells in different parts of the body can appear as side effects many years after your child finishes treatment.
Some people develop a side effect during therapy that continues to affect them after they finish treatment. This is called a long-term effect. Alternatively, health problems may arise many years later. These are called late effects.
Many of the potential long-term effects are a consequence of certain kinds of chemotherapy. Some children also receive radiation to the brain. This is called cranial radiation therapy (CRT). CRT may put your child more at risk for some of the effects discussed in this section.
Much of our current understanding of the long-term and late effects of leukemia treatment comes from the Childhood Cancer Survivor Study (CCSS) that was launched in the early 1990s.
Fortunately, improvements to current leukemia therapies allow many survivors to live normal lives. Many childhood leukemia survivors experience minimal late or long-term effects.
Fertility
When your child enters adulthood, they may start to think about having children. Current treatment methods have improved to such an extent that majority of children with AML are unlikely to face issues with fertility when they are older. If your child receives a bone marrow transplant during their treatment, they may have problems with fertility when they are older.
If your child is diagnosed around the age of puberty (age 11 or 12) or later, you and your child may want to consider banking your child’s sperm. Boys who are pre-pubertal may be able to undergo an experimental procedure called a testicular biopsy. Discuss these options with your child’s doctor if you or your child have any questions or concerns. You may be referred to a fertility preservation team.
Heart problems
During your child’s chemotherapy, they may take medicines called daunorubicin and doxorubicin. They belong to the class of medicines called anthracyclines, which are commonly used to treat many different types of cancers. Depending on the dose, these medicines can be toxic to cells inside the heart. Damage to the heart cells can make it hard for the heart muscle to pump properly. Eventually, the heart just cannot keep up and your child can develop symptoms like fatigue or breathing problems.
If your child received anthracyclines during treatment, they should see a doctor often and have a heart ultrasound (echocardiogram) regularly. Girls treated with anthracyclines who become pregnant later need to have a regular echocardiogram done. These will be done as part of the routine follow-up.
Secondary leukemia
While on chemotherapy, your child takes medicines that work by damaging the DNA of leukemic cells. These drugs are called alkylating agents. One example is Busulfan, which is used before a stem cell transplant. Alongside attacking the cancerous marrow and blood cells, the alkylating agents can also damage the DNA of healthy blood cells. This can cause leukemia for a second time.
Regular check-ups after treatment are important so that your child's doctor can check for any early signs of these cancers.
Complications related to bone marrow transplants
As part of your child’s treatment plan, they may have also received a bone marrow transplant. There are many long-term effects associated with this procedure.