What are the risks and recovery expectations?

Common risks include myelosuppression (low blood counts leading to infection, anemia, or bleeding), mucositis, nausea, and temporary hair loss. More serious but less frequent risks involve organ toxicity (e.g., cardiac, hepatic, or renal) and secondary malignancies. Recovery is gradual: after the intensive initial phases (first 6–9 months), children transition to a less intensive maintenance phase with monthly outpatient visits. Most children can attend school and resume normal activities during maintenance, though close monitoring for side effects continues throughout the 2.5-year protocol.