Long Term Follow Up Post Leukemia Treatment

Updated: October 2010

Drug Toxicity Surveillance

Not including acute toxicity during therapy

The following table summarizes some of the common drug related toxicity seen in the follow up of patients treated for Leukemia.

Drug Class

Toxicity Concern

Monitoring/Surveillance

Notes

Alkylating agents

Secondary MDS/AML

Blood counts

Latent period usually 4-7 years or longer; often associated with deletions of chromosome 7 or complex karyotypes

Topoisomerase II Inhibitors

Secondary MDS/AML

Blood counts

Latent period shorter than alkylators, often 2-3 years after therapy; frequently associated with balanced chromosomal translocations

Anthracyclines

Cardiac Dysfunction

Assessment of ventricular function before treatment; physical exam and focused testing after completion

Role of routine cardiac function testing by echocardiography or radionuclide ventriculogram not clear

Vinca alkaloids

Neuropathy

Clinical examination

Usually reversible but elderly patients in particular may need monitoring

Tyrosine kinase inhibitors

Liver dysfunction, pleural/pericardial effusions, cardiac toxicity

Laboratory monitoring and clinical examination

Variable with specific TKI—review of drug monographs advised for each drug

Purine Analogs

Prolonged immunosuppression and opportunistic infection

History and physical examination

These drugs may inhibit T cell function long after completion of therapy

Drug Class	Toxicity Concern	Monitoring/Surveillance	Notes
Alkylating agents	Secondary MDS/AML	Blood counts	Latent period usually 4-7 years or longer; often associated with deletions of chromosome 7 or complex karyotypes
Topoisomerase II Inhibitors	Secondary MDS/AML	Blood counts	Latent period shorter than alkylators, often 2-3 years after therapy; frequently associated with balanced chromosomal translocations
Anthracyclines	Cardiac Dysfunction	Assessment of ventricular function before treatment; physical exam and focused testing after completion	Role of routine cardiac function testing by echocardiography or radionuclide ventriculogram not clear
Vinca alkaloids	Neuropathy	Clinical examination	Usually reversible but elderly patients in particular may need monitoring
Tyrosine kinase inhibitors	Liver dysfunction, pleural/pericardial effusions, cardiac toxicity	Laboratory monitoring and clinical examination	Variable with specific TKI—review of drug monographs advised for each drug
Purine Analogs	Prolonged immunosuppression and opportunistic infection	History and physical examination	These drugs may inhibit T cell function long after completion of therapy

The information contained in these guidelines is a statement of consensus of Leukemia/BMT Program of BC professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. Use of these guidelines and documents is at your own risk and is subject to the Leukemia/BMT Program of BC’s terms of use available at Terms of Use.