Primary Care for Childhood Survivors of Leukemia

Transition topic.  Fantastic NEJM article outlining primary care for childhood survivors of leukemia.
http://www.nejm.org/doi/full/10.1056/NEJMcp1103645?query=featured_home


Key Points:

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, and 5-year survival rates in the United States have exceeded 70% for over two decades.

Adult survivors of childhood leukemia have increased risks of secondary cancers, cardiovascular disease, and other chronic illnesses, largely secondary to therapies for childhood cancer.

Clinicians caring for adult survivors of childhood leukemia should

• Request a treatment summary from the treating oncologist, a pediatric oncology program, or a local “survivor clinic.”

• Be aware that adults who received cranial radiotherapy as a component of treatment have increased risks of secondary tumors, stroke, growth hormone deficiency, and neurocognitive deficits.

• Check BMI, blood pressure, and lipids, since survivors of ALL have increased risks of obesity and associated metabolic derangements.

• Consider bone-density testing, since peak bone density is often reduced after childhood exposure to high-dose glucocorticoids and other therapies.

• Screen for left ventricular dysfunction in survivors who received anthracycline therapy, particularly if there was a high cumulative dose or treatment was before the age of 5 years.

Identify the Image

Just based on this image alone, what's the diagnosis in this 6 year old boy?

(answer in the first comment)