Table 1

 Important treatments responsible for late effects in acute lymphoblastic leukaemia (ALL) treatment and bone marrow conditioning (a number of other chemotherapy agents are given but are lower risk for late effects)

Treatment for ALL (UKALLXI) 1 includes:Potential late effects include:
Anthracyclines (daunorubicin (180 mg/m2)Cardiomyopathy—risk increases with increasing dose
SteroidsReduced bone density
Obesity
High dose methotrexateReduced bone density
EtoposideSecondary leukaemia
At relapse chemo included:
Anthracyclines (additional 200 mg/m2 epirubicin)Increased risk of cardiomyopathy
Bone marrow conditioningPotential late effects
Total body irradiation (TBI)Second malignancy (particularly skin and thyroid)
Thyroid nodules
Cataracts
Endocrine dysfunction (see table 2)
Gonadal failure
Sicca syndrome
Restrictive lung defect
Cardiac dysfunction
CyclophosphamidePotentiates cardiac effects of anthracyclines
Pulmonary toxicity
Gonadal dysfunction