Late Effects after Treatment of Acute Myeloid Leukemia in Childhood and Adolescence

Acute myelogenous leukemia (AML) accounts for only 15–20% of acute leukemias in children and adolescents. Therapy is extremely intensive with high doses of chemotherapy especially anthracyclines and cytarabine and hematopoietic stem cell transplantation (HSCT) in selected patients. Cranial irradiation was part of the therapy schedule in the AML-BFM protocols in the past. Serious late effects may include cardiomyopathy after treatment with anthracyclines, neurotoxicity after administration of vincristine and/or high-dose cytarabine, and hepatotoxicity after high-dose cytarabine. Cranial irradiation may affect the endocrine system. The cumulative incidence of secondary malignancies is approximately 2% after 10 years. Life-threatening chronic health conditions are significant more frequent after HSCT. Monitoring for late-onset cardiomyopathy is recommended in all AML patients. Long-term follow-up guidelines have been published from the Children’s Oncology Group (COG) (http://www.survivorshipguidelines.org/).