Follow-up after treatment for acute lymphocytic leukemia

Follow-up after treatment is an important part of cancer care. Follow-up for acute lymphocytic leukemia (ALL) is often shared among the cancer specialists (oncologists or hematologists) and your family doctor. Your healthcare team will work with you to decide on follow-up care to meet your needs.

Don’t wait until your next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell your healthcare team if you have:

• fatigue
• a general feeling of discomfort or illness (called malaise)
• loss of appetite
• weight loss
• bleeding or bruising
• frequent infections

The chance of ALL recurring is greatest within 5 years after finishing treatment, so close follow-up is needed during this time. If a relapse occurs, it is usually during treatment or shortly after treatment is completed. It is unusual for ALL to return if there are no signs of the disease 5 years after treatment.

Schedule for follow-up visits

Follow-up after ALL is based on your personal needs. It generally lasts for many years. Follow-up visits for ALL are usually scheduled:

• every few months for 5 years after treatment is finished (even if there are no signs of disease)
• more frequently, likely once or twice a week, for the first 3 months after a stem cell transplant
• less frequently as time goes on (the time between exams will become longer but they will continue indefinitely)

During follow-up visits

During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping.

Your doctor may do a physical exam, which can include:

• measuring vital signs for fever, shortness of breath and rapid heartbeat
• checking the skin for bruising and paleness
• feeling areas of the neck, underarm and groin for any swollen, or enlarged, lymph nodes
• looking in the mouth for signs of infection and bleeding or swollen gums
• feeling the abdomen for enlarged organs
• checking the skeleton for tenderness or pain

Tests are often part of follow-up care. You may have:

• complete blood count (CBC) to check for abnormal blood cell counts
• blood chemistry tests to show how well certain organs are working and find problems caused by the spread of leukemia cells
• imaging tests, such as chest x-ray, CT scan, MRI or ultrasound, to get helpful information about the spleen, liver or lymph nodes
• bone marrow aspiration and biopsy to follow up after the results of the blood tests or if new symptoms develop

If a recurrence is found, your healthcare team will assess you to determine the best treatment options.

Find out more about these tests and procedures.

Questions to ask about follow-up

To make the decisions that are right for you, ask your healthcare team questions about follow-up.