Leukemia - Acute Lymphoblastic - ALL - Childhood: After Treatment

Approved by the Cancer.Net Editorial Board, 03/2014

ON THIS PAGE: You will read about your child’s medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for ALL ends, talk with your child’s doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. All children treated for cancer, including ALL, should have life-long, follow-up care.

Based on the type of treatment your child received, the doctor will determine what examinations and tests are needed to check for long-term side effects. The possible long-term side effects associated with specific treatments are listed in the table below:

Type of Treatment

Possible Late Effects

Chemotherapy with cyclophosphamide (Cytoxan, Neosar) and/or etoposide (VePesid, Toposar)

Secondary cancers

Infertility (the inability to have children)

Chemotherapy with types of drugs called anthracyclines, such as doxorubicin (Adriamycin) or daunorubicin (Cerubidine)

Heart problems

Radiation therapy

Hormone problems affecting growth and metabolism

Secondary cancers


Learning problems

High-dose chemotherapy or spinal fluid injections of chemotherapy like methotrexate (multiple brand names) and cytarabine (Cytosar-U)

Learning problems

Patients should receive follow-up care regularly to monitor for the possible side effects listed above, as well as liver disease from chemotherapy or transfusion-related infection (both very rare) and bone health. At first, check-ups will occur often. Then overtime, these appointments will become more spread apart. Your child’s doctor can recommend the necessary screening tests. Follow-up care should address your child’s quality of life, including any developmental or emotional concerns.

Survivors should be sensitive to their level of functioning and level of stress, and they may need counseling if they have any problems. It is important that children who have trouble with school have neuropsychological testing (testing of thinking skills by a psychologist) to find the cause. Based on the results, the psychologist can advise teachers about changes that can be made in the classroom or teaching plan to help the child learn. Survivors should also be evaluated for bone or joint pain that may result from bone cell death caused by cancer treatments that reduce blood flow in bone joints. The Children’s Oncology Group provides recommendations for follow-up care.

Childhood cancer survivors should also think about the choices available for health insurance when considering their follow-up plan. This Cancer.Net article outlines the basics of Cancer and Affordable Care Act.

The child’s family is encouraged to organize and keep a record of the child’s medical information. That way, as the child enters adulthood, he or she has a clear, written history of the diagnosis, the treatment given, and the doctor’s recommendations about the schedule for follow-up care. The doctor’s office can help you create this. This information will be valuable to doctors who care for your child during his or her lifetime. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment your child received and develop a survivorship care plan once treatment is completed.

Children who have had cancer can also enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating a balanced diet, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs.  Learn more about childhood cancer survivorship and the next steps to take in survivorship.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.