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Long-term survivors of leukemia treated in infancy: factors associated with neuropsychologic status
R K Mulhern1, E Kovnar, J Langston
1Division of Psychology, St Jude Children's Research Hospital, Memphis, TN 38101-0318.
Insights
Children treated for acute lymphoblastic leukemia (ALL) in infancy showed lower IQ and memory function compared to Wilms' tumor survivors. These findings support reduced cranial radiation therapy (CRT) for young ALL patients.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Radiation Oncology
Background:
- Late toxicities of cancer treatment in infants, particularly cranial radiation therapy (CRT), are a significant concern.
- Understanding long-term functional and neuropsychologic outcomes is crucial for optimizing treatment protocols.
Purpose of the Study:
- To compare the functional and neuropsychologic status of long-term survivors of infant-diagnosed acute lymphoblastic leukemia (ALL) with survivors of Wilms' tumor.
- To investigate the impact of CRT dose on neurocognitive outcomes in ALL survivors.
Main Methods:
- Neuropsychologic testing was administered to 26 ALL survivors (diagnosed <24 months) and 26 Wilms' tumor survivors.
- Children with ALL received varying doses of CRT for CNS prophylaxis or relapse, with some receiving no CRT.
- Diagnostic imaging studies were performed on the ALL group.
Main Results:
- No significant difference in global functional status between ALL and Wilms' tumor groups.
- ALL survivors exhibited significantly lower mean IQ, poorer visual/auditory memory, and reduced arithmetic skills.
- A higher frequency of special educational intervention was noted in the ALL group.
- Lower IQ and auditory memory in ALL survivors correlated inversely with CRT dose and time since therapy completion.
Conclusions:
- Results support reducing prophylactic CRT in very young children with ALL, reserving it for those at high risk of CNS relapse.
- Evidence suggests delaying CRT until a later age for infants and young children requiring this treatment.
Purpose:
Because of concerns about late toxicities of treatment among infants diagnosed with acute lymphoblastic leukemia (ALL), and especially the effects of cranial radiation therapy (CRT), we compared the functional and neuropsychologic status of 26 long-term survivors of ALL who were diagnosed in the first 24 months of life versus 26 children who were treated previously for Wilms' tumor.
Patients And Methods:
Of the children with ALL, CNS prophylaxis included no CRT in six, 18 Gy CRT in five, 20 Gy CRT in seven, and 24 Gy CRT in five. Three additional children experienced CNS relapse and received total CRT doses of 24, 40, and 44 Gy. All children received neuropsychologic testing; children with ALL also participated in diagnostic imaging studies.
Results:
As a group, the children who were treated for ALL did not differ significantly from those who were treated for Wilms' tumor on objective measures of global functional status. However, children treated for ALL had a significantly lower mean intelligence quotient (IQ) (87 v 96), poorer performance on four of six measures of visual and auditory memory, lower achievement with regard to arithmetic skills, and a greater frequency of special educational intervention than those who were treated for Wilms' tumor. IQ and auditory memory performance in the ALL group was correlated inversely with time since the completion of therapy and total CRT dose.
Conclusions:
These results reinforce the contemporary trend of prophylactic CRT omission in very young children except for those who are at risk for CNS relapse. For infants and very young children who require CRT, evidence is presented that supports the approach for the delay of CRT until the child is older.