PDF(Pubmed)
Abstract：
The aim of this review is to raise awareness and knowledge among healthcare professionals and policymakers about late adverse effects in survivors of childhood leukemia. With contemporary treatment, over 90% of children with acute lymphoblastic leukemia (ALL) and over 60% with acute myeloid leukemia (AML) are cured. Large cohort studies demonstrate that 20% of ALL and most AML survivors have at least one chronic health condition by 20-25 years after diagnosis. These are life-changing or threatening in some survivors and contribute to increased premature mortality. We describe the frequency, causes, clinical features, and natural history of the most frequent and severe late adverse effects in childhood leukemia survivors, including subsequent malignant neoplasms, metabolic toxicity, gonadotoxicity and impaired fertility, endocrinopathy and growth disturbances, bone toxicity, central and peripheral neurotoxicity, cardiotoxicity, psychosocial late effects, accelerated ageing and late mortality. The wide range of late effects in survivors of haemopoietic stem cell transplant is highlighted. Recent developments informing the approach to long-term survivorship care are discussed, including electronic personalized patient-specific treatment summaries and care plans such as the Survivor Passport (SurPass), surveillance guidelines and models of care. The importance of ongoing vigilance is stressed given the increasing use of novel targeted drugs with limited experience of long-term outcomes. CONCLUSION: It is vital to raise awareness of the existence and severity of late effects of childhood leukemia therapy among parents, patients, health professionals, and policymakers. Structured long-term surveillance recommendations are necessary to standardize follow-up care.
摘要：
本综述的目的是提高医疗保健专业人员和政策制定者对儿童白血病幸存者后期不良反应的认识和知识。在当代治疗中，超过90%的急性淋巴细胞白血病(ALL)患儿和超过60%的急性髓细胞性白血病(AML)患儿已治愈.大型队列研究表明，20％的ALL和大多数AML幸存者在诊断后20-25年至少有一种慢性健康状况。这些改变了一些幸存者的生活或威胁，并导致过早死亡率增加。我们描述了频率，原因,临床特征,以及儿童白血病幸存者中最常见和最严重的晚期不良反应的自然史，包括随后的恶性肿瘤，代谢毒性，性腺毒性和生育能力受损，内分泌疾病和生长障碍，骨毒性，中枢和外周神经毒性，心脏毒性,心理社会晚期影响，加速衰老和晚期死亡。强调了造血干细胞移植幸存者的广泛后期效应。讨论了有关长期生存护理方法的最新发展，包括针对特定患者的电子个性化治疗摘要和护理计划，例如幸存者护照（SurPass），监测指南和护理模式。鉴于新型靶向药物的使用越来越多，长期结果的经验有限，因此强调了持续警惕的重要性。结论:提高家长对儿童白血病治疗晚期效应的存在和严重程度的认识至关重要,病人,卫生专业人员,和政策制定者。结构化的长期监测建议对于标准化后续护理是必要的。
