Long-term complications of childhood leukemia that benefit from early diagnosis
| Long-term complications . | Screening and diagnostic tools . | Early intervention . |
|---|---|---|
| Secondary tumors Thyroid cancer Breast cancer Skin cancer Meningioma and other brain tumors | Thyroid US Mammography, US, MRI Clinical screening Brain MRI/CT as clinically indicated | Early oncological management |
| Cardiac and vascular risk Anthracycline-related cardiomyopathy Metabolic syndrome | Calculation of anthracyclines cumulative dose (doxorubicin-equivalent dose), echocardiography (with global longitudinal strain) Metabolic parameters (weight, abdominal circumference, fasting glycemia, insulin level and lipid profiles, HbA1c) | Cardioprotective drugs (eg, angiotensin-converting enzyme inhibitors), cardiovascular risk Nutritional and physical activity intervention, lipid-lowering and antidiabetic medications |
| Development Delayed puberty Growth retardation Neurodevelopment | Puberty assessment (Tanner) Growth chart analysis and follow-up Endocrine evaluation Focused clinical evaluation of neurodevelopment | Induction of puberty Hormone therapy Educational support and interventions |
| Iron overload | Number of RBC transfusions, posttreatment ferritin levels, liver function tests, MRI liver iron quantification | Phlebotomy, iron chelation |
| Infertility | Calculation of alkylating agent cumulative dose (cyclophosphamide-equivalent dose), AMH levels | Early postcancer fertility counseling |
| Long-term complications . | Screening and diagnostic tools . | Early intervention . |
|---|---|---|
| Secondary tumors Thyroid cancer Breast cancer Skin cancer Meningioma and other brain tumors | Thyroid US Mammography, US, MRI Clinical screening Brain MRI/CT as clinically indicated | Early oncological management |
| Cardiac and vascular risk Anthracycline-related cardiomyopathy Metabolic syndrome | Calculation of anthracyclines cumulative dose (doxorubicin-equivalent dose), echocardiography (with global longitudinal strain) Metabolic parameters (weight, abdominal circumference, fasting glycemia, insulin level and lipid profiles, HbA1c) | Cardioprotective drugs (eg, angiotensin-converting enzyme inhibitors), cardiovascular risk Nutritional and physical activity intervention, lipid-lowering and antidiabetic medications |
| Development Delayed puberty Growth retardation Neurodevelopment | Puberty assessment (Tanner) Growth chart analysis and follow-up Endocrine evaluation Focused clinical evaluation of neurodevelopment | Induction of puberty Hormone therapy Educational support and interventions |
| Iron overload | Number of RBC transfusions, posttreatment ferritin levels, liver function tests, MRI liver iron quantification | Phlebotomy, iron chelation |
| Infertility | Calculation of alkylating agent cumulative dose (cyclophosphamide-equivalent dose), AMH levels | Early postcancer fertility counseling |
AMH, anti-Mullerian hormone; CT, computed tomography; Hb, hemoglobin; MRI, magnetic resonance imaging; RBC, red blood cell; US, ultrasound.