No major cognitive impairment in young children with acute lymphoblastic leukemia using chemotherapy only: a prospective longitudinal study

J Pediatr Hematol Oncol. 2002 Feb;24(2):106-14. doi: 10.1097/00043426-200202000-00010.

Abstract

Purpose: To study, using serial neuropsychological assessment and evaluation of school achievement, persistent neuropsychological late effects in children treated for acute lymphoblastic leukemia (ALL) at a young age with chemotherapy only.

Patients and methods: Twenty consecutive patients underwent three evaluations, including 12 psychometric measures beside IQ. The authors applied strict methodology and a prospective-longitudinal design that started at diagnosis and extended to a median follow-up of 7 years. This report focuses on the outcome of the last evaluation. Test results were compared with healthy controls and to patients with ALL treated on a previous chemotherapy-only protocol. School achievement was evaluated in patients and their siblings.

Results: At the last evaluation, significantly lower test scores in patients compared with controls were found for only 2 of 14 cognitive measures (1 intelligence and 1 attention measure). No great differences were seen between school achievement of patients and siblings. Compared with the previous chemotherapy protocol, a better outcome was seen in the current study group on two measures (one memory and one attention measure).

Conclusions: Children surviving ALL have no major cognitive impairment after chemotherapy, including intrathecal and high-dose intravenous methotrexate. The slightly better outcome in the current group may indicate possible adverse effects of more dexamethasone treatment in the previous group.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Asparaginase / administration & dosage
  • Asparaginase / adverse effects
  • Attention / drug effects
  • Child, Preschool
  • Cognition Disorders / chemically induced*
  • Cognition Disorders / epidemiology
  • Cyclophosphamide / administration & dosage
  • Cyclophosphamide / adverse effects
  • Cytarabine / administration & dosage
  • Cytarabine / adverse effects
  • Dexamethasone / administration & dosage
  • Dexamethasone / adverse effects
  • Female
  • Follow-Up Studies
  • Humans
  • Ifosfamide / administration & dosage
  • Ifosfamide / adverse effects
  • Injections, Spinal
  • Learning Disabilities / chemically induced
  • Learning Disabilities / epidemiology
  • Longitudinal Studies
  • Male
  • Mercaptopurine / administration & dosage
  • Mercaptopurine / adverse effects
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects
  • Netherlands / epidemiology
  • Neuropsychological Tests
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / epidemiology
  • Prednisone / administration & dosage
  • Prednisone / adverse effects
  • Prospective Studies
  • Survivors / psychology*
  • Teniposide / administration & dosage
  • Teniposide / adverse effects
  • Treatment Outcome
  • Vincristine / administration & dosage
  • Vincristine / adverse effects

Substances

  • Cytarabine
  • Vincristine
  • Dexamethasone
  • Cyclophosphamide
  • Teniposide
  • Mercaptopurine
  • Asparaginase
  • Ifosfamide
  • Prednisone
  • Methotrexate

Supplementary concepts

  • BFM-86 protocol