Childhood Cancer

Childhood Cancer

Long-term side effects

Increasing numbers of children are being cured of their disease and surviving years after a single or tandem PBSCT. The intensity of the treatment prior to, during, and after transplant can cause major effects that are not apparent for months or even years. This section describes a few of the possible long-term side effects that sometimes develop after transplant.

Dental development

Certain chemotherapy drugs, administered in high doses prior to transplant, may result in improper tooth development and blunted or absent tooth roots in children who had a transplant when they were younger than age 5. Your child should have a comprehensive dental exam prior to the transplant and a dental follow-up every 6 to 12 months after recovery from the PBSCT.

Thyroid function

Children who receive only chemotherapy before transplant do not usually develop thyroid deficiency. If, however, your child receives radiation therapy to the head, neck, or chest, either before or after a transplant, she should have lifelong monitoring for thyroid deficiency. Tablets containing thyroid hormone are effective in treating the problem if it develops.

Puberty and fertility

The risk of puberty or fertility problems is not well known for transplants in which the marrow is not completely destroyed (e.g., tandem transplants). For this reason, boys who have gone through puberty should bank sperm, if possible, before treatment begins. You may also consider experimental protocols that are attempting to preserve fertility in girls. Any child or teen who had a transplant should be followed closely by a pediatric endocrinologist who can prescribe hormones if necessary (testosterone for boys, estrogen and progesterone for girls) to assist in normal pubertal development and who can assess fertility in older survivors.

Second cancers

Children who receive a PBSCT have a small risk of developing a second cancer. The risk depends on the chemotherapy drugs given and whether any radiation treatment was given.

Because transplants are relatively new treatments for children and teens with solid tumors, the overall impact and long-term effects are not yet clear. Your child’s oncologist can explain known risks given your child’s disease and treatment. You can also read about late effects in Childhood Cancer Survivors: A Practical Guide to Your Future, 3rd ed. by Nancy Keene, Wendy Hobbie, and Kathy Ruccione. It is very important that any child who had a transplant be followed for life by an expert in the late effects of treatment for childhood cancer. Many of these late effects, if found early, are treatable.

Image

The road of chemotherapy treatment was long and harsh, but transplant was a test of faith and patience. Knowing that Mia’s immune system would be zapped to the point of no return was scary. However, it felt like the last step in killing off any sign of cancer in my little girl’s body and a step closer to the end of this nightmare. Isolation was tough on both of us but once again the staff, the programs, the volunteers, and everyone in the hospital were amazing. Mia’s room was personalized and decorated just for her. She only asked to leave the room the day before we left for good, day 38! The nurses and doctors did everything in their power to make the whole transplant process go as smoothly as possible for all of us. They kept us informed, called us on their days off, helped me clean Mia up when she was sick, and even played dress up to help get her out of bed and to the shower. We survived, and Mia was discharged on day 39. She walked out dressed like a princess.