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Pre-clinical Evaluation of Tyrosine Kinase Inhibitors for Treatment of Acute Leukemia
Published on: September 18, 2013
Chemotherapeutic CNS prophylaxis and neuropsychologic change in children with acute lymphoblastic leukemia: a
K A Espy1, I M Moore, P M Kaufmann
1Department of Psychiatry, Southern Illinois University, Carbondale, IL 62901-6503, USA. kespy@siumed.edu
Insights
Prophylactic central nervous system (CNS) chemotherapy for childhood acute lymphoblastic leukemia may lead to modest declines in arithmetic, visual motor integration, and verbal fluency. Treatment type and demographic factors influence these long-term neurocognitive outcomes.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Childhood Cancer Survivorship
Background:
- Childhood acute lymphoblastic leukemia (ALL) treatment often involves central nervous system (CNS) prophylaxis.
- The long-term neurocognitive effects of these treatments require thorough investigation.
Purpose of the Study:
- To assess the association between CNS chemotherapy for childhood ALL and subsequent neuropsychological abilities.
- To identify factors influencing neurocognitive outcomes and changes over time.
Main Methods:
- Longitudinal study using growth curve analysis in 30 children treated for ALL.
- Comprehensive neuropsychological testing at baseline and at 2, 3, and 4 years postdiagnosis.
Main Results:
- Modest declines observed in arithmetic, visual motor integration, and verbal fluency.
- Combined intrathecal and systemic treatment correlated with poorer visual motor integration and faster skill decline compared to intrathecal treatment alone.
- Maternal education influenced arithmetic proficiency, but not its rate of decline.
Conclusions:
- Neuropsychological outcomes and decline rates in childhood ALL survivors are influenced by a combination of demographic factors and treatment characteristics.
- Cognitive domain-specific effects highlight the need for personalized follow-up care.
Objective:
To determine whether prophylactic CNS chemotherapy for childhood acute lymphoblastic leukemia is associated with declines in neuropsychological abilities.
Methods:
Growth curve analysis was used to examine neuropsychological outcome and treatment-related change in children (N = 30) who were treated at two childhood cancer centers. A comprehensive test battery was administered at baseline (8 months), 2, 3, and 4 years postdiagnosis (age at diagnosis M = 5.90 years, SD = 4.2C).
Results:
Results indicated modest declines in arithmetic, visual motor integration, and verbal fluency. Intrathecal and systemic treatment was related to poorer visual motor integration at 4 years postdiagnosis and a faster rate of decline in visual motor integration skills across the observation period than intrathecal treatment alone. Arithmetic proficiency at 4 years after diagnosis was related to maternal education, but the rate of decline was not. Verbal fluency was unrelated to demographic or treatment variables.
Conclusions:
These findings suggest that neuropsychological outcome and declines are related to both demographic and treatment characteristics depending on the cognitive domain examined.
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