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Neuropsychological outcome in chemotherapy-only-treated children with acute lymphoblastic leukemia
Nathalie C A J Jansen1, Annette Kingma, Arnout Schuitema
1Department of Pediatric Hematology Oncology, Beatrix Children's Hospital Groningen, University Medical Center Groningen, University of Groningen, PO Box 30,001, 9700 RB Groningen, the Netherlands. N.C.A.Jansen@umcutrecht.nl
Insights
Children treated for acute lymphoblastic leukemia (ALL) showed no significant long-term neurocognitive deficits compared to siblings, except for fine-motor skills. Physical complaints in patients correlated with lower attention and speed.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Childhood Cancer Survivors
Background:
- Children treated for acute lymphoblastic leukemia (ALL) undergo intensive chemotherapy, raising concerns about potential long-term neurocognitive effects.
- Understanding the trajectory of neuropsychological functioning is crucial for supportive care and educational planning for these survivors.
Purpose of the Study:
- To prospectively evaluate neuropsychological functioning over time in children treated exclusively with chemotherapy for acute lymphoblastic leukemia (ALL).
- To compare the neurocognitive outcomes of ALL patients with their siblings and normative data.
Main Methods:
- A nationwide, prospective-longitudinal, sibling-controlled study included 49 children treated for ALL with intrathecal and systemic chemotherapy.
- Neuropsychological assessments covering learning, memory, attention, speed, executive, visual-constructive, and fine-motor functions were conducted at diagnosis, 3-6 months post-treatment, and 4.5 years post-diagnosis.
- Multilevel analyses were used to compare patient performance over time with 29 siblings and normative data.
Main Results:
- No significant differences in overall neuropsychological performance were observed between ALL patients and their siblings, with both groups generally performing within the normal range.
- The ALL patient group exhibited significantly lower performance in complex fine-motor functioning compared to siblings at the final evaluation.
- Patients reporting physical complaints (pain/tiredness) at diagnosis showed significantly lower attention and processing speed compared to siblings in later assessments.
Conclusions:
- Four and a half years post-diagnosis, children treated for ALL with chemotherapy alone did not display evident negative neuropsychological late effects, with the exception of complex fine-motor skills.
- Significant practice effects were noted in both patients and siblings across several tasks, highlighting the importance of repeated assessments.
- Poorer sustained attention in ALL patients with initial physical complaints and observed practice effects warrant consideration in future longitudinal research.
Purpose:
To evaluate neuropsychological functioning over time in children treated for acute lymphoblastic leukemia (ALL) with chemotherapy only.
Patients And Methods:
Forty-nine consecutive patients (median age at first assessment, 6.8 years; range, 4.0 to 11.8 years) treated with intrathecal and systemic chemotherapy were included in a nationwide, prospective-longitudinal, sibling-controlled study. Patients and siblings completed three extensive neuropsychological assessments: at diagnosis, 3 to 6 months after completion of (2-year) treatment and 4.5 years after diagnosis. Assessments included measures of learning, memory, attention, speed, executive functioning, visual-constructive functioning, and fine-motor functioning. Multilevel analyses were applied to evaluate patients' performances over time and to compare patients to 29 siblings (median age of siblings at first assessment, 8.2 years; range, 4.5 to 12.6 years) and to normative data.
Results:
No major differences were found in neuropsychological performance between patients and siblings, with both groups performing mainly in the normal range. The patient group as a whole, however, scored significantly lower than the siblings on complex fine-motor functioning at the last evaluation. Large practice effects were found for both patients and siblings in four of 11 tasks. Patients who uttered physical complaints (ie, pain and/or tiredness) at the first pretreatment assessment scored significantly lower than siblings on attention and speed at the last two evaluations.
Conclusion:
Despite intensive and potentially neurotoxic treatment, no evident negative, neuropsychological late effects were found 4.5 years after diagnosis, except for effects on complex fine-motor functioning. Both the large practice effects observed and the poorer performances on sustained attention for patients with physical complaints should be reckoned with in prospective, longitudinal neuropsychological research in children.
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