Supportive Care During Therapy for Childhood Acute Lymphoblastic Leukemia

This chapter offers a comprehensive overview of the critical interventions aimed at supporting patients with acute lymphoblastic leukemia (ALL) from diagnosis to the end of treatment. The focus is on proactive anticipation of complications and preemptive measures to minimize short-term and long-term adverse effects of the disease and its therapy. This includes addressing oncologic emergencies at diagnosis, providing hematologic supportive care, preventing and managing infections, and promoting optimal nutrition and fitness. At time of diagnosis, patients may experience life-threatening complications such as leukostasis, superior mediastinal syndrome and tumor lysis syndrome as a consequence of a large tumor burden. Managing these complications requires multidisciplinary expertise and care. Throughout treatment, most patients with ALL require transfusion support, and it is important to maintain the balance between avoiding complications of cytopenias and judicious use of blood products. Infections remain the primary cause of treatment-related morbidity and mortality in ALL. While a few consensus guidelines for prophylaxis against bacterial, fungal, and viral prophylaxis have been developed, local microbial profiles and chemotherapy intensity should guide current practices. Optimal nutrition and physical activity during ALL therapy have shown to benefit not only quality of life, but also reduce treatment-related toxicities and improve response to chemotherapy. Continuous reassessment of goals and individualized approaches for each patient and family are crucial to achieve these goals. As therapies for ALL evolve, supportive care strategies must parallel these changes based on a thorough understanding of the mechanism of action of established and novel therapies and the pathophysiology of their adverse effects.