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Immediate and long-term posttherapy neuropsychologic performance in children with acute lymphoblastic leukemia
Insights
Children with acute lymphoblastic leukemia (ALL) receiving intrathecal methotrexate for CNS prophylaxis showed no significant neuropsychologic impairment. Long-term follow-up confirmed sustained cognitive function without global deficits.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Clinical Neurology
Background:
- Intrathecal methotrexate is a common method for central nervous system (CNS) prophylaxis in acute lymphoblastic leukemia (ALL).
- Concerns exist regarding potential neurocognitive effects of CNS-directed therapies in pediatric cancer survivors.
- This study addresses the long-term impact of specific prophylactic regimens on cognitive function.
Purpose of the Study:
- To evaluate intellectual and neuropsychologic test performance in children treated for acute lymphoblastic leukemia (ALL) with intrathecal methotrexate.
- To compare cognitive outcomes in ALL patients with a control group of children with embryonal rhabdomyosarcoma (ERMS) without CNS involvement.
- To assess long-term changes in cognitive function in a subset of ALL patients.
Main Methods:
- Neuropsychologic testing was conducted on 41 children with ALL within one year of completing therapy.
- A control group of 33 children with ERMS (no CNS disease or treatment) was included for comparison.
- Patients were stratified into younger (<8 years) and older (≥8 years) age groups at testing.
Main Results:
- No significant differences in intellectual function were observed between the ALL and ERMS groups, overall or within age strata.
- Long-term follow-up (5 years) of 12 ALL patients revealed no significant changes in intellectual or specific neuropsychologic functions.
- Children with ALL treated with intrathecal methotrexate and no CNS radiation demonstrated no global or specific neuropsychologic impairment.
Conclusions:
- Prophylactic intrathecal methotrexate in children with ALL, without CNS radiation, is not associated with significant long-term neurocognitive impairment.
- These findings support the safety of this specific CNS prophylaxis regimen regarding cognitive outcomes.
- Pediatric ALL survivors in continuous complete remission exhibit preserved cognitive function when treated with this regimen.
Abstract:
Intellectual and neuropsychologic test performance was studied in 41 children with acute lymphoblastic leukemia within one year of completing multidrug therapy in which intrathecal methotrexate was the sole agent of central nervous system prophylaxis. To control for possible effects of intensive systemic chemotherapy and the disruptive psychosocial effects of treatment on psychometric test function, 33 children with embryonal rhabdomyosarcoma who had no CNS disease or treatment were similarly studied. All patients studied had been in continuous complete remission since diagnosis. Within each diagnostic group, patients were placed in a younger (less than 8 years) or an older (more than 8 years) group depending on age at the time of testing. No significant difference was found in intellectual function between the young ALL and ERMS groups or between the total ALL and ERMS groups. Further five-year follow-up of 12 of the youngest ALL patients showed no significant long-term change in intellectual or other specific neuropsychologic functions. Children with ALL who remained in continuous complete remission from diagnosis and who were treated with prophylactic intrathecal methotrexate and no CNS radiation did not have global or specific neuropsychologic impairment.