Other late effects of leukemia

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Learn potential issues that can result from treatment for acute lymphoblastic leukemia (ALL).

Key points

  • Certain boys who have been treated with radiation and children who received a bone marrow transplant (BMT) may have problems with fertility.
  • Children who have received chemotherapy may experience heart problems.
  • Children who have received radiation may develop thyroid problems.

Fertility issues, heart and thyroid problems, and complications from a bone marrow transplant are all possible effects from acute lymphoblastic leukemia (ALL) treatment.


When your child enters adulthood, they may start to think about having children. Current ways of treating acute lymphoblastic leukemia (ALL) have improved to such an extent that the majority of children with ALL are unlikely to face issues with fertility when they are older. However, this depends on the type of therapy they receive. For example, some boys require treatment with radiation directed to their testes, which can cause infertility. Talk to your child's doctor to discuss any concerns you may have.

Children who received a bone marrow transplant (BMT) may have problems with fertility when they are older.

If your child is diagnosed around the age of puberty (age 11 or 12) or later, you and your child may want to consider banking your child’s sperm. Boys who are pre-pubertal may be able to undergo an experimental procedure called a testicular biopsy. Discuss these options with your child’s doctor if you or your child has any questions or concerns. You may be referred to a fertility preservation team. Depending on the individual treatment and doses, girls might be at risk for premature ovarian failure.

Heart problems

During your child’s chemotherapy, they may take medicines called daunorubicin and doxorubicin. They belong to the class of medicines called anthracyclines, which are commonly used to treat many different types of cancers. Depending on the dose, these medicines can be toxic to cells inside the heart. Damage to the heart cells can make it hard for the heart muscle to pump properly. Eventually, the heart just cannot keep up and your child can develop symptoms like fatigue or breathing problems.

If your child received anthracyclines during treatment, they should see a doctor often and have a heart ultrasound (echocardiogram) regularly. Girls treated with anthracyclines who become pregnant later need to have a regular echocardiogram done. These will be done as part of the routine follow-up.

Thyroid problems

If your child receives radiation therapy, they may later develop problems in the thyroid, which is a butterfly-shaped organ at the bottom of our neck. Our thyroid gland excretes hormones which regulate our body weight, heart rate, and how we use energy.

Radiation can interrupt this process, causing the thyroid to produce fewer hormones than it normally does. This condition is called hypothyroidism. If left untreated, hypothyroidism can cause weight gain, fatigue, and other health problems.

Your child’s doctor will check for signs of hypothyroidism during follow-up visits. If your child develops the hypothyroidism, the doctor will prescribe a synthetic thyroid hormone, which is safe and effective.

Complications related to bone marrow transplants

As part of your child’s treatment plan, they may have also received a bone marrow transplant. There are many long-term effects associated with this procedure.

Last updated: March 6th 2018