Side effects of treatment
Intravenous and oral chemotherapy have well established short term side effects that include -:
- Fatigue
- Hair loss
- Nausea and vomiting
- Diarrhoea
- Weight gain
Steroid drugs - including prednisolone and dexamethasone
These drugs are used in short bursts during chemotherapy treatment. Side effects can include -:
- significant weight gain,
- osteoporosis leading to fractures of long bones or vertebrae
- diabetes mellitus
Rarer side effects include -:
- psychiatric problems ranging from depression and anxiety to full blown psychotic episodes.
- osteonecrosis particularly in hips and knees; patients may require joint replacement in the longer term.
Biological therapy with Imatinib or Dasatinib
These drugs usually cause minimal side effects. Some children may experience loss of appetite, nausea or diarrhoea. Rare but serious adverse effects are liver toxicity and bone marrow suppression.
CNS-directed therapy in the form of intrathecal chemotherapy or cranial irradiation may have the following side effects -:
- Fits (5-10% of children having intrathecal chemotherapy will experience fits as a side effect)
- Myelopathy – damage to the spinal cord by drugs – numbness, tingling or difficulty moving are likely symptoms. Peripheral neuropathy – numbness or tingling are common symptoms. This is usually partially or completely reversible over time.
- Very severe tiredness is seen with cranial irradiation and may be called ‘somnolence syndrome’ in the medical evidence- the child sleeps all the time
- Acute cerebellar syndrome – difficulty balancing when walking or difficulty walking at all are likely symptoms
CNS therapy may lead to ongoing neurological problems including learning difficulties that persist in to adult life which can be mild to severe.
Long term side effects of chemotherapy treatment
In the long term young people and children who have had intensive chemotherapy are at significant risk of long term side effects of treatment – these are summarised here -:
- Second cancers – this is 1 in 20 over the 15 to 20 years after treatment for ALL.
- Lung damage
- Heart disease
- Learning difficulties (related to CNS-directed therapy)
- Behavioural problems (related to CNS-directed therapy)
