Monitoring

Patients with ALL should be closely monitored for recurrence of the disease and development of complications. Frequent hospitalizations may be required to deal with complications, particularly neutropenic fever.

During acute illness and chemotherapy, all patients should receive antimicrobial prophylaxis. Prevention of herpes virus reactivation can be accomplished with acyclovir. During periods of severe neutropenia, prophylaxis with a fluoroquinolone antibiotic is often used.[157] Patients should receive trimethoprim/sulfamethoxazole prophylaxis (or an alternative) to prevent Pneumocystis jirovecii pneumonia infection.[157][192]​ Fungal prophylaxis (e.g., using fluconazole, itraconazole, or posaconazole) should be considered, though mold infections in ALL are generally less common than with acute myeloid leukemia.[156] [ Cochrane Clinical Answers logo ] ​ Azole antifungals can interfere with metabolism and clearance of vincristine, so either the dose of vincristine should be reduced or the azole substituted with an alternative agent (e.g., an echinocandin, liposomal amphotericin B).[194]

Maintaining good body and mouth hygiene is of high importance. This may include the use of antibacterial mouthwashes such as chlorhexidine.[178][207]​​[208]

Details on the late effects of cancer treatment can be found online: Children's oncology group: long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers Opens in new window

Monitoring for relapse

After initial therapy, patients are followed up at routine intervals to monitor for treatment-related complications and relapsed disease. At these visits, patients' history, physical examinations, and blood work are evaluated. Bone marrow aspiration and biopsy are performed at predetermined intervals depending on the regimen used.

Evaluation of suspected relapse

Patients who relapse usually present with bone marrow involvement. Up to one third of patients have concurrent involvement of extramedullary sites (e.g., central nervous system, testes, skin, pleura) at relapse.[138]

Evaluation of suspected relapse is similar to diagnostic workup at first presentation.

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