Late effects in survivors of infantile acute leukemia: a study of the L.E.A program

Studies of long-term survivors of childhood leukemia have shown that many patients have significant late effects due to their treatment. 1 Because of the rarity and poor prognosis of infant leukemia, 2 , 3 , 4 , 5 few papers on the late effects in this population have been published, whereas the use of maximally intensified therapies to improve survival rates and the vulnerability of these young children to complications and acute toxicity present major challenges. 6 We examined a cohort of long-term survivors included in the Leucémies de l’Enfant et de l’Adolescent program (L.E.A.) who were <1 year of age at diagnosis without any Down syndrome or other congenital genetic abnormalities and studied the influence of age in months, sex, the type of leukemia and the use of hematopoietic stem cell transplantation (HSCT) to investigate the incidence of and risk factors for late sequelae of treatment in infants. Details of the program have been previously described. 7 All patients (or their parents) provided written informed consent. Late effects were detected by physicians through regular visits to reference centers, starting 1 year after HSCT or after completion of chemotherapy and comprised a medical examination and adequate laboratory tests. The following late effects were assessed in the entire cohort: height, weight, body mass index (BMI), gonadal function, hypothyroidism, cardiac function, iron overload, cataract, alopecia, osteonecrosis, diabetes, metabolic syndrome, central nervous system (CNS) complications and viral infection. Health Quality of Life (HQoL) of children and adolescents was assessed using the parents’ version of the Vécu et Santé Perçue de l’Adolescent et l’enfant (VSP-Ap) which is completed by the parents of the children and adolescents. 8 Adult patients were asked to complete SF-36 questionnaires. 9