TABLE 3.

Profile of late effects risks by common pediatric malignancies

Pediatric malignancy	Contemporary frontline therapeutic modalities*	Potential late effects†
Acute lymphoblastic leukemia & Non-Hodgkin lymphoma	Glucocorticoids Vinca alkaloids Antimetabolites Anthracyclines Alkylating agents	Bone mineral density deficits Peripheral and/or sensory neuropathy Cognitive deficits Cardiomyopathy Gonadal dysfunction/infertility
Acute myeloid leukemia	Anthracyclines Antimetabolites Epipodophyllotoxins	Cardiomyopathy
Ewing sarcoma	Surgical resection Epipodophyllotoxins Alkylating Agents Anthracyclines Vinca alkaloids Primary/metastatic site irradiation	Functional deficits Secondary leukemia Gonadal dysfunction/infertility Cardiomyopathy Peripheral and/or sensory neuropathy Subsequent neoplasms
Hodgkin lymphoma	Glucocorticoids Vinca alkaloids Anthracyclines Alkylating agents Involved node radiation	Bone mineral density deficits Peripheral and/or sensory neuropathy Cardiomyopathy Pulmonary fibrosis Gonadal dysfunction/infertility Hypothyroidism Subsequent neoplasms
Medulloblastoma	Surgical resection Vinca alkaloids Alkylating agents Heavy metals Craniospinal irradiation	Neurologic deficits Peripheral and/or sensory neuropathy Neuroendocrine dysfunction Gonadal dysfunction/infertility Hearing loss Renal dysfunction Cognitive deficits Vasculopathy/stroke
Neuroblastoma	Surgical resection Epipodophyllotoxins Alkylating agents Anthracyclines Heavy metals Immunotherapy	Secondary leukemia Gonadal dysfunction/infertility Hearing loss Renal toxicity Cardiomyopathy Subsequent neoplasms
Osteosarcoma	Surgical resection Antimetabolites Alkylating agents Heavy metals	Functional deficits Renal dysfunction Gonadal dysfunction/infertility Cardiomyopathy Hearing loss
Rhabdomyosarcoma	Surgical resection Vinca alkaloids Anthracyclines Involved site radiation	Peripheral and/or sensory neuropathy Cardiomyopathy Subsequent neoplasms
Wilms tumor	Nephrectomy Vinca alkaloids Anthracyclines Primary/metastatic site irradiation	Renal dysfunction Kyphoscoliosis Peripheral and/or sensory neuropathy Gonadal dysfunction/infertility Cardiomyopathy Subsequent neoplasms

^*Exposures listed may vary as therapy is stratified based on clinical and pathological features of pediatric malignancy and early response to therapy.

^†The risk of specific late effects varies in magnitude based on specific agents and modalities and dose; survivors with favorable and responsive malignancies may have substantially lower risks for specific late effects due to limited exposures of the agents and modalities listed.