Curing children of cancer is wonderful, but it is not without other risks, as we are beginning to learn. In 1964 only 2% of children with acute lymphocytic leukemia (ALL) survived five years.1 Now, if treated with optimal therapy, 50% of these children survive five years or longer.2 With increased survival, ALL in childhood has revealed its heterogeneous nature. It appears to be a mixture of diseases as indicated by dissimilar natural histories related to such factors as cell surface markers and cytogenetic abnormalities.3,4 Prognosis is related to these characteristics as well as to age at onset, sex, and initial WBC count.5 The risk of ALL is increased in certain families,6 after childhood radiation exposure,7 and in some immunodeficiency states.8
Increased survival in ALL has also generated increased reporting of second malignant neoplasms as described by Mosijczuk and Ruymann in this issue of
ANN GILMAN P, MILLER RW. Cancer After Acute Lymphocytic Leukemia. Am J Dis Child. 1981;135(4):311–312. doi:10.1001/archpedi.1981.02130280001001
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