title: Providing primary care for long-term survivors of childhood acute lymphoblastic leukemia.
abstract: Primary care physicians will be providing longitudinal health care for long-term survivors of childhood acute lymphoblastic leukemia (ALL) with increasing frequency. Late effects (sequelae) secondary to treatment with radiation or chemotherapeutic agents are frequent and may be serious. Depending on treatment exposures, this at-risk population may experience life-threatening late effects, such as cirrhosis secondary to hepatitis C or late-onset anthracycline-induced cardiomyopathy, or life-changing late effects, such as cognitive dysfunction. Many survivors of childhood ALL will develop problems such as obesity and osteopenia at a young age, which will significantly affect their risk for serious health outcomes as they grow older. The goal of our review is to assist primary care physicians in providing longitudinal health care for long-term survivors of childhood ALL. We also highlight areas needing further investigation, including the prevalence of different late effects, determination of risk factors associated with a late effect, a better understanding of the potential impact of late effects on the premature development of common adult health problems, and the value and timing of different tests for screening asymptomatic survivors.
authors.affiliation: Department of Family Practice and Community Medicine, University of Texas Southwestern Medical Center at Dallas, and Children's Medical Center of Dallas, 75390-9067, USA. kevin.oeffinger@email.swmed.edu
authors.forename: K C
authors.initials: KC
authors.lastname: Oeffinger
authors.forename: D A
authors.initials: DA
authors.lastname: Eshelman
authors.forename: G E
authors.initials: GE
authors.lastname: Tomlinson
authors.forename: M
authors.initials: M
authors.lastname: Tolle
authors.forename: G W
authors.initials: GW
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000375:Aging; D001851:Bone Diseases, Metabolic / Q000209:etiology; D009202:Cardiomyopathies / Q000139:chemically induced; D002648:Child; D003072:Cognition Disorders / Q000209:etiology; D006304:Health Status; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology; D008137:Longitudinal Studies; D009765:Obesity / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy*; D011320:Primary Health Care; D012307:Risk Factors; D017741:Survivors; D016896:Treatment Outcome