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Trajectory of Neurocognitive Functioning in Children Treated for Acute Lymphoblastic Leukemia (ALL): Dana-Farber

Alexandra Thrope1, Sameera Ramjan2, Charlie White3

  • 1Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Pediatric Blood & Cancer
|January 10, 2026
PubMed

Insights

Children treated for acute lymphoblastic leukemia (ALL) may experience neurocognitive changes. Older age and female sex are linked to poorer outcomes in attention and memory, suggesting a need for early intervention.

Area of Science:

  • Pediatric Oncology
  • Neuroscience
  • Clinical Psychology

Background:

  • Children undergoing treatment for acute lymphoblastic leukemia (ALL) face risks of neurocognitive deficits.
  • These deficits can affect attention, working memory, executive functions, and psychomotor speed.

Purpose of the Study:

  • To evaluate longitudinal neurocognitive trajectories in children with newly diagnosed ALL.
  • To identify medical and demographic factors associated with these neurocognitive outcomes during treatment.

Main Methods:

  • 298 patients aged 3-21 with ALL were assessed using Cogstate at four timepoints.
  • Linear mixed models analyzed trajectories and interactions with clinical factors, accounting for patient and site variability.

Main Results:

  • Significant longitudinal changes were observed in executive functioning, attention, visual learning, and working memory accuracy (p < 0.001).
  • Older age correlated with worse psychomotor function and working memory speed, while female sex was associated with poorer psychomotor and working memory accuracy but better visual learning and working memory speed.
  • A notable proportion of participants performed below -1.5 SD in attention, executive functioning, and psychomotor functioning.

Conclusions:

  • Most patients showed normal neurocognitive functioning with variable trajectories.
  • A subgroup exhibited poor performance in attention, executive functioning, and psychomotor skills.
  • Older age at diagnosis and female sex are identified as risk factors, highlighting potential targets for early intervention.
Abstract

Keywords:
acute lymphoblastic leukemiacognitionneurocognitive outcomesrisk factors

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