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Neuropsychological abnormalities following CNS prophylaxis in children with acute lymphatic leukemia
Y Jain1, V P Choudhry, L S Arya
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Insights
Children treated for acute lymphoblastic leukemia (ALL) with cranial irradiation and methotrexate show significant neuropsychological deficits. These findings highlight the need for modified central nervous system (CNS) prophylaxis and regular psychometric evaluations for long-term patient rehabilitation.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Childhood Cancer Therapy
Background:
- Combination central nervous system (CNS) prophylaxis involving cranial irradiation and intrathecal methotrexate is a standard treatment for acute lymphoblastic leukemia (ALL).
- Potential long-term neurocognitive sequelae of this intensive prophylaxis regimen in pediatric ALL survivors are a significant concern.
Purpose of the Study:
- To investigate the pattern and prevalence of neuropsychological abnormalities in children treated with combination CNS prophylaxis for ALL.
- To compare the neurocognitive performance of ALL patients with age-matched healthy siblings.
Main Methods:
- A cohort of 35 children (5-15 years) treated for ALL and 20 healthy siblings were assessed.
- Neuropsychological evaluations included tests for general intelligence (WISC), attention/concentration (Colour Cancellation), memory (PGI Memory Test), and visuomotor perception (Bender Gestalt).
- Assessments were conducted at least 6 months post-CNS prophylaxis.
Main Results:
- ALL patients exhibited significantly lower mean intelligence quotients (IQ) compared to controls (93.4 vs. 107; p < 0.001).
- Six patients (17.1%) had IQs below 85, while all controls scored above 85 (p < 0.05).
- Patients showed deficits in attention/concentration (p < 0.01) and memory (p < 0.001) compared to controls, but visuomotor perception was not significantly different.
Conclusions:
- Combination CNS prophylaxis for ALL is associated with significant neuropsychological abnormalities, including impaired intelligence, attention, and memory.
- These findings suggest a need to reconsider and potentially modify current CNS prophylaxis schedules.
- Regular, comprehensive psychometric evaluations are crucial for identifying deficits and guiding long-term rehabilitation strategies for ALL survivors.
Abstract:
The pattern and prevalence of neuropsychological abnormalities in children receiving combination CNS prophylaxis (2000 rads cranial irradiation and intrathecal methotrexate) during therapy for acute lymphoblastic leukemia (ALL) were studied. Thirty five children (25 boys) in the age group 5-15 years (mean 9.3) with no evidence of CNS leukemia were included and 20 age matched normal siblings served as controls. Neuropsychological parameters of general intelligence (Malin's modification of WISC test); attention and concentration (colour cancellation test); memory (modified PGI memory test) and visuomotor perception (Bender Gestalt test) were evaluated at least 6 months after CNS prophylaxis. Six (17.1%) patients had mean intelligence quotients (IQ) less than 85, while all controls had IQ > 85 (p < 0.05). The mean IQ of the patient population (93.4 +/- 11.9) was significantly lower than the control group (107 +/- 8.4) (p < 0.001). Scores on the colour cancellation test were lower in the patients as compared to controls (148.7 +/- 27.7 versus 184.9 +/- 23.9; p < 0.01). The mean memory quotient in the patient population was also lower than in controls (74.5 +/- 12 versus 93.6 +/- 9.2; p < 0.001). Scores on the Bender-Gestalt test did not show a significant difference. The presence of significant neuropsychological abnormalities in patients of ALL indicates the need for modification of the schedule of CNS prophylaxis. A comprehensive psychometric evaluation at regular intervals is essential for longterm rehabilitation.