Side effects

Long-term survival of children with leukaemia has improved dramatically over recent decades. But unfortunately modern treatments, so successful in saving young lives, carry the risk of some serious side-effects.

Whilst efforts continue to improve survival rates still further, a major aim of current clinical trials is to reduce the incidence and severity of adverse effects of treatment.

Short-term effects

Kidney damage
There is a risk of kidney damage as a result of the high levels of uric acid released when the tumour cells are killed. Drugs can be given to guard against this effect but sometimes the destruction of cells is so rapid that a condition called tumour-lysis occurs and temporary use of an artificial kidney may be required.

Risk of infection and bleeding
The powerful drugs used to treat leukaemia affect a child’s bone marrow and the ability of the marrow to produce blood cells. This causes problems such as infection, bleeding and anaemia.

The more intensive the treatment is, the more likely the child is to experience these serious side effects. A high level of supportive care – including antibiotics, antifungal drugs, red blood cell transfusions and platelet transfusions - is required to protect against these risks.

Hair loss
Hair loss is an inevitable but temporary side-effect of chemotherapy.

Other effects
Children may also experience nausea, vomiting, loss of appetite and weight loss.

Long-term effects

The long-term effects of chemotherapy depend on the drugs used and the intensity of treatment. Because of the combinations of drugs which are used, it is difficult to establish which drugs are responsible for which effects.

Documented side-effects have included cardiac problems, infertility and secondary cancers.

Cranial and spinal irritation
The main risk of long-term effects is in children who receive cranial and spinal irradiation to prevent central nervous system (CNS) relapse. For this reason only a minority of children now receive cranial irradiation routinely.

Use of cranial and spinal irradiation is associated with impairment of growth and educational achievement and with premature onset of puberty. In order to minimise the risk of these effects children receive the absolute minimum dose of radiotherapy necessary to prevent CNS relapse.

Infertility
In the small number of cases where whole-body irradiation has been given as part of the preparation for a stem cell transplant it is likely that the child will be made sterile.

There may also be impairment of hormone production by the testes or ovaries and children may require hormone replacement therapy to attain puberty. Boys with testicular disease may require localised radiotherapy to the testes and the younger the age at which this is done, the more severe the impact on testes function.

Spinal or total body irradiation may also affect the thyroid gland and children will be given regular tests as they may require thyroid supplements.