Late Effects in Pediatric AML Survivors

Identification of high-risk groups, optimized treatment strategies, and advanced supportive care measures have significantly improved survival for children diagnosed with acute myeloid leukemia (AML). This success, however, has not been without cost. As the number of AML survivors has increased, successive studies have described the impact these intensified therapies have had on the late mortality and long-term health of children treated for this disease. Early reports described effects upon growth, development, and major organ systems, while larger cohorts, with more follow-up time, have more comprehensively characterized and graded the severity of these late outcomes. Additionally, recent reports have also evaluated neurocognitive and physical function outcomes among these survivors. This chapter summarizes the prevalence of and risk-factors for long-term and late effects affecting survivors of pediatric AML. Gaps in the literature, concerning late outcomes associated with newer immune-based therapies, genetic influences, and the impact of social determinants of health, are highlighted. Ongoing international efforts in drug development and newer therapeutics combined with comprehensive long-term surveillance will continue to advance cures and improve life-long health and quality of life for these children as they grow into adulthood.