Related Experiment Videos
Neurodevelopmental outcome of infants with acute lymphoblastic leukemia: a Children's Cancer Group report
T A Kaleita1, G H Reaman, W E MacLean
1University of California Los Angeles School of Medicine, USA.
Insights
Infants with acute lymphoblastic leukemia (ALL) treated with high-dose methotrexate (MTX) show positive neurodevelopmental outcomes. This approach improves results for young ALL patients compared to past treatments.
Area of Science:
- Pediatric Oncology
- Neurodevelopmental Pediatrics
- Hematology
Background:
- Infants with acute lymphoblastic leukemia (ALL) face high risks of central nervous system (CNS) disease.
- CNS-directed therapy can lead to adverse developmental outcomes in these vulnerable patients.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes of infants treated for ALL with high-dose methotrexate (MTX) for CNS-directed therapy.
- To assess the impact of CNS-directed treatment on cognitive and motor development in young ALL survivors.
Main Methods:
- Thirty infants diagnosed with ALL in remission were assessed post-therapy using the McCarthy Scales of Children's Abilities.
- CNS-directed treatment involved high-dose MTX infusions and intrathecal chemotherapy.
- Parental questionnaires gathered sociodemographic information.
Main Results:
- Mean scores across all cognitive and motor indices were within the average range, comparable to population standards.
- No patients exhibited developmental disabilities or neurologic disorders.
- Risk factors like age, gender, additional CNS treatment, and socioeconomic status did not correlate with developmental outcomes.
Conclusions:
- High-dose MTX as CNS-directed therapy yields generally positive neurodevelopmental outcomes for infants with ALL.
- This treatment strategy represents a significant advancement in improving neurodevelopmental outcomes for very young ALL patients.
- Combined with reduced CNS relapse rates, this approach offers a better prognosis for infants treated for ALL.
Background:
Infants diagnosed with acute lymphoblastic leukemia (ALL) are considered the patient subgroup at the highest risk for central nervous system (CNS) disease, both at presentation and as an isolated extramedullary relapse. In addition, they are highly vulnerable to adverse developmental sequelae from CNS-directed therapy.
Methods:
Thirty patients younger than 12 months at diagnosis (12 males, 18 females) in first hematologic remission were evaluated after completion of ALL therapy (mean age = 62.1 months; standard deviation = 17.2 months; range = 38-102 months). CNS-directed treatment included very high dose infusions of methotrexate (MTX) and intrathecal cytarabine and MTX. Three patients had meningeal leukemia that required additional therapy. Children were administered the McCarthy Scales of Children's Abilities, and parents completed a sociodemographic questionnaire to obtain information about occupation and education.
Results:
Mean scores on all 6 cognitive and motor indices of the McCarthy Scales were in the average range (Verbal = 52.0; Perceptual = 53.6; Quantitative = 49.6; General Cognitive Index [GCI] = 102.1; Memory = 49.2; Motor = 51.0). Score distributions for each neurodevelopmental index were comparable to age-based population standards. One patient obtained a GCI that exceeded 2 standard deviations above the mean; none scored more than 2 standard deviations below. There was no report of developmental disabilities or neurologic disorders for any of the patients. Risk factors, including age at diagnosis, gender, additional CNS-directed treatment, and family socioeconomic status, were not associated with developmental outcome.
Conclusions:
Test findings indicated a generally positive neurodevelopmental outcome for ALL patients diagnosed in infancy who were treated with very high dose MTX as CNS-directed therapy. Combined with the reduction in the isolated CNS relapse rate achieved by the Children's Cancer Group (CCG) clinical trial CCG-107, the results of this study represent a substantial improvement in neurodevelopmental outcome for very young patients compared with infants treated for ALL in the past.