Complications

Acute lymphocytic leukemia is responsible for about 1,490 deaths a year in the US, and it can progress quickly if untreated. However ALL is one of the most curable cancers and survival rates are now at an all-time high. Both the oldest and very young age groups tend to have lower survival rates, usually because the leukemia that develops in these patient groups tends to have genetic features that produce a more severe condition.

Outlook in Children with ALL. Survival rates in children with cancer, and leukemia in particular, have increased from 53 - 85% in North America over the past 3 decades.

Certain children are at higher risk for a poor outcome than others:

• African American and Hispanic children appear to have a poorer outcome than Non-Hispanic Caucasian children, but this may not be due to biological differences in the response to treatment. A 2003 study found that with equal access to effective therapy, all children can expect the same high rate of cure.
• Survival rates in boys tend to be lower than in girls. The reason for this is not known, although it may be partially due to the boys' higher risks for less favorable genetic profiles and for T-cell ALL.
• Survival rates in infants are improving but they are still poor. The best results are in children age 1 to 9 years old. Older children may require more aggressive treatment.
• The prognosis may vary depending on other risk factors as well, including the subtype of the cancer, how high the white blood count is, degree of organ involvement, and genetic background.
• Although children with precursor-B and early precursor-B tend to have a better prognosis than patients with the B-cell stage and T-cell types of ALL, advances in treatment are improving the outlook for patients with all these latter types.

Responding well to early treatment is a good sign regardless of the risk category.

Outlook in Adults with ALL. Adults tend to have a more severe condition than children, even if they are carrying the same ALL genes. Between 60 - 80% of adults with ALL can expect to achieve full remission with standard treatments and between 35 - 40% survive beyond 2 years with aggressive treatments. Younger adults with ALL have better long-term survival rates than older adults with the disease.

Long-Term Physical Effects of Treatments

The intense treatments required by ALL can have serious short- and long-term side effects. Some long-term complications of particular concern are discussed here as well as in the section on treatments.

Fatigue and General Feelings of Ill Health. Long-term effects of the disease and its treatments may include fatigue and general aches and pains, which can have a negative impact on daily life.

Osteoporosis. Loss of bone density (osteoporosis) is a side effect of corticosteroids. Patients or their parents should discuss approaches to reduce this risk. Many therapies of protecting bone are available.

Osteoporosis is a condition that causes progressive loss of bone density, thinning of bone tissue, and an increased risk of fractures. Osteoporosis may result from disease, dietary or hormonal deficiency, or advanced age. Regular exercise and vitamin and mineral supplements can reduce and may even reverse bone loss.

Heart Disease. Some of the treatments increase risk factors for future heart disease, including unhealthy cholesterol levels and high blood pressure. Patients with ALL should be sure to maintain a healthy lifestyle and be regularly monitored for heart risks to help reduce these effects.

Click the icon to see an image of cholesterol.

Obesity. Children treated for ALL are at higher risk for obesity, possibly because the treatments trigger an earlier than normal occurrence in childhood weight gain. Corticosteroids, drugs used in treatments, also increase appetite, which contributes to the problem. One study indicated, however, that lifestyle factors, such as adopting a pattern of reduced physical activity during treatment, plays the major role in this complication.

Impaired Mental and Neurologic Functioning. Cranial radiation and drugs used in chemotherapy, especially specific corticosteroids and intrathecal treatments may impair mental functioning and cause neurologic problems, such as movement problems. Advances in cranial radiation may reduce the neurologic and mental risks from this treatment, but it can occur with many other treatments as well. A 2001 report suggested that methylphenidate (Ritalin) may improve mental performance in children.

Infections. Some children may be more vulnerable to infections after completing chemotherapy, although the immune system tends to improve over time. Studies now suggest that young survivors of leukemia have an increased risk for measles, mumps, and rubella (MMR), even if they have been previously vaccinated. Children, then, may need reimmunization.

Impaired Physical Growth. Cranial radiation can result in impaired growth.

Infertility. Chemotherapy, cranial radiation, or both can impair fertility in male and female patients.

Secondary Cancer. Rarely secondary cancers, most often leukemia (generally acute myeloid leukemia), can later develop.

Psychologic and Mental Consequences

Studies are finding that survivors of childhood leukemia tend to have more psychological problems, including stress, depression, anger, and confusion, than their physically healthy siblings. As adults, they are also more likely to be unemployed or working part time. Risk for mood psychological problems may vary by treatment. A 2003 study showed that patients who received high-dose CNS radiation and methotrexate therapy had an increased risk of mood disturbances compared to those who did not receive radiation.

Recognizing this risk and getting psychologic support early may be important and helpful. Nevertheless, in one 2002 study, young survivors reported satisfaction with life, a sense of purpose, and an ability to cope because of their experiences with cancer. A 2004 study confirmed these results, reporting that 81% of adult survivors of childhood ALL had a positive self-concept.

Effects on Caregivers

One study found that parents who take care of children with ALL developed more symptoms of post-traumatic stress disorder than their children.

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Review Date: 12/17/2005
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital