Quiz: Late Treatment Effects in Survivors of Pediatric Leukemia

Which agents are associated with increased risk of sarcomas in childhood leukemia? What are the most common secondary cancers among survivors of childhood leukemias, lymphomas, and other childhood malignancies? Take this multiquestion quiz to find out.

Question 1

Answer

A.Cyclophosphamide

According to a 2017 analysis of long-term outcomes of the Dutch Childhood Cancer Oncology Group–Long-Term Effects After Childhood Cancer (DCOG LATER) cohort, published in the Journal of Clinical Oncology, at a median follow-up of nearly 21 years, cyclophosphamide treatment is associated with a significantly increased risk of adult sarcomas. Treatment during childhood with doxorubicin was associated with a dose-dependent increase in the risk of breast cancer during adulthood, particularly among survivors of Li-Fraumeni syndrome–associated childhood leukemias and brain cancers. A separate study published in JAMA in 2017 similarly showed that cyclophosphamide was associated with a dose-dependent increase in the risk of subsequent malignancies among survivors of childhood leukemia and other pediatric cancers.

Question 2

Answer

D.Breast and thyroid cancers

According to a retrospective, multicenter cohort study of 5-year cancer survivors diagnosed before age 21 years, published in JAMA, at a median follow-up of nearly 21 years, the most common secondary cancers among survivors of childhood leukemia and other childhood malignancies are breast and thyroid cancers. Radiation dose reductions between the 1970s and 1990s were associated with reduced risks of secondary malignancies.

Question 3

Answer

D.20%

Up to 20% of survivors of childhood ALL suffer from CIPN. A recent study that employed quantitative sensory testing found that large-fiber neuropathy may affect up to two-thirds of survivors, and small-fiber neuropathy and pain sensitization affects approximately one-third of survivors.

Question 4

Answer

C.20% to 80%

According to the NCIs PDQ report on late effects of treatment for childhood cancer, between 20% and 80% of survivors of childhood cancers experience severe or life-threatening late effects of treatment during adulthood. Female survivors face a “steeper trajectory of age-dependent decline in health status” during adulthood than do males. Findings from the Childhood Cancer Survivor Study showed that, compared with siblings not diagnosed with leukemia or other pediatric malignancies, survivors are significantly more likely to experience adult cancers, renal failure, stroke, and heart attack.

Question 5

Answer

E.All of the above

The American Society of Clinical Oncology (ASCO) Cancer.Net website provides clinicians, patients, and caregivers with survivorship information about childhood ALL and other pediatric malignancies. The Cancer.Net editorial board advises that survivors of childhood cancer should participate in follow-up clinics to learn about potential late effects of treatment, as well as screening and monitoring for those late effects. The severity of late effects and the risk of secondary cancers can be reduced by avoiding alcohol, illicit drugs, tobacco products and secondhand tobacco smoke, and excessive sun exposure; and by using skin protection against sunburn, following a healthy low-fat and high-fiber diet, engaging in regular exercise, and receiving recommended vaccinations, including immunization against human papillomavirus.