Çocuklarda Akut Lenfoblastik Lösemi Tedavisinin Erken ve Geç Yan Etkileri

Yıl 2014, Cilt: 8 Sayı: 1, 46 - 54, 01.12.2014

Arzu Akyay Lale Olcay

Öz

Akut lenfoblastik lösemi (ALL) çocukluk çağı kanserleri içinde en sık görülenidir ve tüm çocukluk çağı kanserlerinin %30’unu oluşturur. 1980’lerden bu yana ALL’de sağkalım oranları belirgin şekilde artmış, beş yıllık genel sağkalım oranları %80’nin üzerine çıkmıştır. Sağkalımdaki en büyük başarı standardize edilmiş tedavi protokolleri ile ilişkilidir. Sağkalım oranlarındaki bu başarı oranları ile birlikte hastalığın seyri ve tedavi protokollerinin ağır olması, erken ve geç dönemde tedavi ilişkili ciddi yan etkileri de beraberinde getirmektedir. Bu yan etkilerin çoğu tedavinin ilk bir yılı içinde, indüksiyon döneminde veya hemen sonrasında ortaya çıkmaktadır. Birçok hastada geç dönemde de kanserin kendisine veya tedavisine bağlı kronik fiziksel ve psikolojik problemler de tespit edilebilmektedir. Bu derlemenin amacı ALL tedavisine bağlı erken ve geç dönemde ortaya çıkabilecek yan etkilerin gözden geçirilmesidir.

Anahtar Kelimeler

Akut lenfoblastik lösemi, Tedavi, Yan etkil

Early and Late Side Effects of Acute Lymphoblastic Leukemia Therapy in Children

Öz

Acute lymphoblastic leukemia (ALL) is the most common form of cancer in children, comprising approximately 30 percent of all childhood malignancies. Survival rates for ALL have improved dramatically since the 1980s, with current fi ve-year overall survival rates estimated at greater than 80 percent. This improvement in survival is due to treatment of a large number of children on sequential standardized research protocols. While the vast majority of children with ALL enjoy long-term survival/cure, the serious nature of the disease, as well as the aggressiveness of the treatment protocols have resulted in signifi cant early and late treatment-related mortality. Much of the treatment-related mortality occurs during the fi rst year of ALL treatment, often during induction or shortly thereafter. Many long-term survivors of childhood cancer will also develop chronic physical or psychosocial problems as a result of their cancer or its therapy. The purpose of this paper is to review the early and late effects of ALL therapy

Anahtar Kelimeler

Acute lymphoblastic leukemia, Treatment, Side effect

Kaynakça

• Silverman LB. Acute lymphoblastic leukemia. In: Orkin SH, Fisher DE, Lux SE, Ginsburg D, Nathan DG (eds). Oncology of Infancy and Childhood. 1st ed. Philadelphia: Elsevier, 2009:297-330.
• Smith OP, Hann IM. Clinical features and therapy of lymphoblastic leukemia. In: Arceci RJ, Hann IM, Smith OP (eds). Pediatric Hematology. 3rd ed. Oxford: Blackwell, 2006:450-81.
• Howard SC, Ribeiro RC, Pui CH. Acute complications. In: Pui CH (ed). Childhood leukemias. 2nd ed. New York: Cambridge University Pres, 2006:709-49.
• Chow EJ, Friedman DL, Stovall M, Yasui Y, Whitton JA, Robison LL, et al. Risk of thyroid dysfunction and subsequent thyroid cancer among survivors of acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer 2009;53:432-7.
• Ross JA, Oeffi nger KC, Davies SM, Mertens AC, Langer EK, Kiffmeyer WR, et al. Genetic variation in the leptin receptor gene and obesity in survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study. J Clin Oncol 2004;22:3558-62.
• Oudin C, Simeoni MC, Sirvent N, Contet A, Begu-Le Coroller A, Bordigoni P, et al. Prevalence and risk factors of the metabolic syndrome in adult survivors of childhood leukemia. Blood 2011;117:4442-8.
• Mills JL, Fears TR, Robison LL, Nicholson HS, Sklar CA, Byrne J. Menarche in a cohort of 188 long-term survivors of acute lymphoblastic leukemia. J Pediatr 1997;131:598-602.
• Bowers DC, Liu Y, Leisenring W, McNeil E, Stovall M, Gurney JG, et al. Late-ocuuring stroke among long-term survival of childhood leukemia and brain tumors: a report from the childhood cancer survivor study. J Clin Oncol 2006;24:5277-82.
• Goldsby RE, Liu Q, Nathan PC,Bowers DC, Yeaton-Massey A, Raber SH, et al. Late-occurring neurologic sequelae in adult survivors of childhood acute lymphoblastic leukemia: A report from the Childhood Cancer Survivor Study. J Clin Oncol 2010;28: 324-31.
• Harten G, Stephani U, Henze G, Langermann HJ, Riehm H, Hanefeld F. Slight impairment of psychomotor skills in children after treatment of acute lymphoblastic leukemia. Eur J Pediatr 1984;142:189-97.
• Moore IM, Espy KA, Kaufmann P, Kramer J, Kaemingk K, Miketova P, et al. Cognitive consequences and central nervous system injury following treatment for childhood leukemia. Semin Oncol Nurs 2000;16:279-90.
• Jankovic M, Brouwers P, Valsecchi MG, Van Veldhuizen A, Huisman J, Kamphuis R, et al. Association of 1800 cGy cranial irradiation with intellectual function in children with acute lymphoblastic leukaemia. ISPACC. International study group on psychosocial aspects of childhood cancer. Lancet 1994;344:224-27.
• Cousens P, Waters B, Said J, Stevens M. Cognitive effect of cranial irradiation in leukaemia: A survey and meta-analysis. J Child Psychol Psychiatry 1988;29:839-52.
• Silverman LB, McLean TW, Gelber RD, Donnelly MJ, Gilliland DG, Tarbell NJ, et al. Intensifi ed therapy for infants with acute lymphoblastic leukemia: Results from Dana Farber Cancer Instute Consortium. Cancer 1997;80:2285-95.
• Mulhern RK, Fairclough D, Ochs J. A prospective comparison of neuropyschologic performans of children surviving leukemia who recieved 18-Gy, 24-Gy, or no cranial radiation. J Clin Oncol
• Thompson SJ, Leigh L, Christensen R, Xiong X, Kun LE, Heideman RL, et al. Immediate neurocognitive effects of methylphenidate on learning-impaired survivors of childhood cancer. J Clin Oncol 2001;19:1802-8.
• Singal PK, Iliskovic N. Doxorubicin-induced cardiomyopathy. N Engl J Med 1998;339:900-5.
• Ek T, Josefson M, Abrahamsson J. Multivariate analysis of the relation between immune dysfunction and treatment intensity in children with acute lymphoblastic leukemia. Pediatr Blood Cancer
• adult survivors of childhood acute lymphoblastic leukaemia (ALL)
• or non-Hodgkin lymphoma (NHL). Clin Endocrinol 2008;69: 819-27.
• Strauss AJ, Su JT, Dalton VM, Gelber RD, Sallan SE, Silverman LB. Bony morbidity in children treated for acute lymphoblastic leukemia. J Clin Oncol 2001;19:3066-72.
• Halton JM, Atkinson SA, Fraher L, Webber C, Gill GJ, Dawson S, et al. Mineral homeostasis and bone mass at diagnosis in children with acute lymphoblastic leukemia. J Pediatr 1996;126:557-64.
• Nygaard R, Clausen N, Siimes MA, Márky I, Skjeldestad FE, Kristinsson JR, et al. Reproduction following treatment for childhood leukemia: A population-based prospective cohort study of fertility and offspring. Med Pediatr Oncol 1991;19:459-66.
• Byrne J, Fears TR, Mills JL, Zeltzer LK, Sklar C, Nicholson HS,et al. Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2004;42: 589-97.
• Pajari U, Lannig M. Developmental defects of teeth in survivors of childhood ALL are related to the therapy and age at diagnosis. Med Pediatr Oncol 1995;24:310-4.
• Dahllöf G. Craniofacial growth in children treated for malignant diseases. Acta Odontol Scand 1998;56:378-82.
• Neglia JP, Meadows AT, Robison LL, Hertz H, Jonmundsson GK, Lanning M, et al. Second neoplasms after acute lymphoblastic leukemia in childhood. N Engl J Med 1991;325:1330-6.
• Borgmann A, Zinn C, Hartmann R, Herold R, Kaatsch P, Escherich G, et al. Secondary malignant neoplasms after intensive treatment of relapsed acute lymphoblastic leukaemia in childhood. Eur J Cancer 2008;44:257-68.
• Relling MV, Rubnitz JE, Rivera GK, Boyett JM, Hancock ML, Felix CA, et al. High incidence of secondary brain tumours after radiotherapy and antimetabolites. Lancet 1999;354:34-9.
• Fontana M, Stanton C, Pompili A, Amadori S, Mandelli F, Meloni G,et al. Late multifocal gliomas in adolescents previously treated for acute lymphoblastic leukemia. Cancer 1987;60:1510-8.
• Banerjee J, Pääkkö E, Harila M, Herva R, Tuominen J, Koivula A,et al. Radiation-induced meningiomas: a shadow in the success story of childhood leukemia. Neuro Oncol 2009;11:543-9.
• Pui CH, Behm FG, Raimondi SC, Dodge RK, George SL, Rivera GK, et al. Secondary acute myeloid leukemia in children treated for acute lymphoid leukemia. N Engl J Med 1989; 321:136-42. 3584-92.
• Thomas IH, Donohue JE, Ness KK, Dengel DR, Baker KS, Gurney JG. Bone mineral density in young adult survivors of acute lymphoblastic leukemia. Cancer 2008;113:3248-56.