Renal, gastrointestinal, and hepatic late effects in survivors of childhood acute myeloid leukemia treated with chemotherapy only--a NOPHO-AML study.
BACKGROUND
We investigated the spectrum, frequency, and risk factors for renal, gastrointestinal, and hepatic late adverse effects in survivors of childhood acute myeloid leukemia (AML) without relapse treated with chemotherapy alone according to three consecutive AML trials by the Nordic Society of Pediatric Hematology and Oncology (NOPHO).


METHODS
A population-based cohort of children treated for AML according to the NOPHO-AML-84, -88, and -93 trials included 138 eligible survivors of whom 102 (74%) completed a questionnaire and 104 (75%) had a clinical examination and blood sampling performed. Eighty-five of 94 (90%) eligible sibling controls completed a similar questionnaire. Siblings had no clinical examination or blood sampling performed.


RESULTS
At a median of 11 years (range 4-25) after diagnosis, renal, gastrointestinal, and hepatic disorders were rare both in survivors of childhood AML and in sibling controls, with no significant differences. Ferritin was elevated in 21 (21%) AML survivors but none had biochemical signs of liver damage. Viral hepatitis was present in three and cholelithiasis in two AML survivors. One adult survivor had hypertension, two had slightly elevated systolic blood pressure, and eight survivors had slightly elevated diastolic blood pressure. These persons all had normal creatinine and cystatin C levels. Marginal abnormalities in potassium, magnesium, calcium, or bicarbonate levels were found in 34 survivors.


CONCLUSIONS
Survivors of childhood AML treated with chemotherapy only experienced few renal, gastrointestinal, and hepatic late effects.
Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark.
Anne-Sofie
AS
Skou
Heidi
H
Glosli
Kirsi
K
Jahnukainen
Marianne
M
Jarfelt
Guðmundur K
GK
Jónmundsson
Johan
J
Malmros-Svennilson
Karsten
K
Nysom
Henrik
H
Hasle
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D011379:Prognosis; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult
acute myeloid leukemia; children; gastrointestinal; hepatic; late effects; renal