What follow-up care and monitoring should be considered for a patient in remission from ALL?

The provided guidelines do not specifically detail follow-up care for Acute Lymphoblastic Leukemia (ALL) in remission. However, general principles for follow-up and survivorship care for other cancers, such as Non-Hodgkin's Lymphoma and brain tumours, can offer relevant considerations for long-term patient management.

• Follow-up for Remission (General Principles from Non-Hodgkin's Lymphoma):
  • For people in complete remission after first-line treatment with curative intent for diffuse large B-cell lymphoma, regular clinical assessment is offered ¹.
  • Consider stopping regular clinical assessment aimed at detecting relapse 3 years after completing treatment for people in ongoing complete remission ¹.
  • Offer urgent appointments to people who experience a recurrence of lymphoma symptoms or new symptoms that suggest disease relapse ¹.
  • Do not offer LDH surveillance or routine surveillance imaging (including chest X-ray, CT, and PET-CT) for detecting relapse in people who are asymptomatic ¹.
• Survivorship Care (General Principles from Non-Hodgkin's Lymphoma):
  • Provide end-of-treatment summaries for people (and their GPs), discussing personal and general risk factors, including late effects related to their lymphoma subtype and/or its treatment ¹.
  • Provide information on how to recognise possible relapse and late effects of treatment ¹.
  • At 3 years after treatment completion, consider switching surveillance of late effects of treatment to nurse-led or GP-led services ¹.
  • Discuss exercise and lifestyle from diagnosis onwards ¹.
  • Ensure people have a named key worker at diagnosis and during treatment, and contact details for the specialist team after treatment ¹.
  • Information and support should cover communication, treatment details (benefits, short-term risks, late effects), financial support, fertility issues, sexual function, support groups, and access to wellbeing services and psychological support ¹.
• Surveillance for Late-Onset Side Effects (General Principles from Brain Tumours):
  • Be aware that people who have had cancer treatment can develop side effects months or years later, which may include cataracts, cognitive decline, epilepsy, hearing loss, hypopituitarism, infertility, neuropathy, radionecrosis, secondary tumours, SMART (stroke-like migraine attacks after radiotherapy), and stroke ³.
  • Assess the person's individual risk of developing late effects when they finish treatment, record these in their written treatment summary, and explain them to the person ³.
  • Encourage a healthy lifestyle, including exercise, a healthy diet, and stopping smoking, to decrease the risk of stroke ³.
  • For people at risk of stroke, consider checking their blood pressure, HbA1c level, and cholesterol profile regularly ³.
  • Consider ongoing neuropsychology assessment for people at risk of cognitive decline ³.
  • If a person has had a radiotherapy dose that might affect pituitary function, consider checking their endocrine function regularly after the end of treatment ³.
  • Consider referring people at risk of visual impairment for an ophthalmological assessment ³.
  • Consider referring people at risk of hearing loss to audiology for a hearing test ³.