Baseline Neurocognitive Functioning Among Children Treated for Acute Lymphoblastic Leukemia (ALL): Dana Farber Cancer
Sameera Ramjan1, Melanie Blair Thies1, Yuelin Li1
1Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Insights
Most childhood acute lymphoblastic leukemia (ALL) patients showed normal neurocognition at diagnosis. Older age, male sex, and higher relapse risk were linked to initial cognitive delays in some children with ALL.
Area of Science:
- Neuroscience
- Pediatric Oncology
- Cognitive Psychology
Background:
- Childhood acute lymphoblastic leukemia (ALL) treatment can impact neurocognitive functioning.
- Early assessment of cognitive function is crucial for identifying at-risk children.
Purpose of the Study:
- To describe neurocognitive functioning in children with ALL during the first month of induction chemotherapy.
- To examine associations between neurocognition and factors like age, sex, relapse risk, socioeconomic status, and oxidative stress.
Main Methods:
- Utilized the Cogstate assessment tool on 330 children with ALL across eight North American sites.
- Collected baseline data within the first month after diagnosis.
- Analyzed relationships between neurocognitive performance and demographic/clinical variables.
Main Results:
- Over 63% of participants performed within normal age-expected limits.
- Older age correlated with slower psychomotor speed, attention, and working memory.
- Male sex was associated with faster psychomotor speed; females showed stronger visual learning.
- Higher relapse risk linked to slower psychomotor speed and attention deficits.
- No association found between neurocognition and maternal education, household material hardship, or oxidative stress at baseline.
Conclusions:
- Most children with ALL do not exhibit cognitive impairments at baseline, but a subset shows age-related delays.
- Age, sex, and ALL risk classification identify subgroups with potential baseline neurocognitive delays.
- Lack of baseline impact from socioeconomic factors and oxidative stress allows for future monitoring of treatment-induced changes.
Background:
This study describes neurocognitive functioning during the first month of induction chemotherapy for childhood acute lymphoblastic leukemia (ALL) and associations with age, sex, risk of relapse, maternal education, household material hardship (HMH), and oxidative stress.
Methods:
Patients treated on protocol 16-001 (NCT03020030) across eight North American sites (2017-2022) consented for optional testing using Cogstate at six timepoints throughout treatment. The baseline data presented were collected within the first month after diagnosis.
Results:
Among 406 eligible patients, 330 (81%) consented (53% males, mean age = 8.8 years, SD = 4.7). Over 63% of participants performed within normal limits for their age range. Additionally, no relationship was observed at baseline between neurocognition and maternal education, HMH, or oxidative stress. In contrast, a linear relationship was observed between older age and weaker psychomotor speed (p < 0.0001), attention (p < 0.0001), and working memory (p = 0.019). Males also demonstrated faster psychomotor speed (p = 0.0027), while females demonstrated stronger visual learning (p = 0.011). Furthermore, having a higher risk of relapse was associated with slower psychomotor speed (p = 0.006) and weaker attention (p = 0.033).
Conclusions:
Our findings indicate that most ALL patients in this study who were assessed at baseline did not display cognitive impairments, except for a small subset of participants who were below age expectations across domains. These baseline findings also identify subgroups based upon age, sex, and ALL risk classification that begin medical treatment with neurocognitive delays, warranting monitoring to elucidate whether exposure to therapy further impacts these domains. Additionally, the lack of impact on neurocognitive functioning at baseline of maternal education, HMH, and/or oxidative stress enables subsequent assessments to effectively identify the potential emergence of deficits as a result of exposure to medical treatment.
