Learning difficulties in children treated for acute lymphoblastic leukaemia (ALL)

Abstract

Concern about the adverse affects of brain irradiation used in treatment for childhood leukaemia on children's learning have been put forward since the 1960s. Early work based on assessment of IQ suggested considerable problems associated with CNS irradiation of 2400cGy, and that children who were younger on diagnosis (below 5 years) were particularly at risk. Consequently, new protocols were introduced in which the amount of irradiation was reduced, or children were treated by chemotherapy alone. There is some evidence that reduction from 2400 to 1800cGy irradiation is beneficial, especially for younger children, as is treatment by chemotherapy alone. Methodological problems in conducting this work and limitations in relying on IQ tests are discussed. Where there are no indications of differences in survival, there would seem to be implications for reducing as far as possible the use of CNS directed therapy among young children treated for leukaemia.

Adolescence and Socioeconomic Factors: Key Factors in the Long-Term Impact of Leukemia on Scholastic Performance—A LEA Study

“…The mean age at inclusion of the 855 participants was 16.2 ± 7.0 years, and the mean follow-up from diagnosis to evaluation was 10.2 ± 6.2 years. After disease onset, 244 patients (28.5%) repeated a grade, with a median interval of four years [interquartile range [2][3][4][5][6][7][8]. Independent factors associated with repeating a grade were to be a boy (OR = 1,78 [1.21-2.60]), to be adolescent (OR = 2,70 [1.63-4,48]), having an educational support during the treatment period (OR = 3,79 [2,45 -5,88]), low level of parents' education (OR = 2,493 [1,657 -3,750]), and household financial difficulties (OR=2,62 [1,607 -4,28]).…”

“…Several studies have addressed cognitive and learning impairment and their risk factors in children following cancer (1,2). As a result, treatment has been adapted to age and relapse risk to minimize neurocognitive toxicity by, for example, less use of cranial irradiation (3,4). Page 4 of 30 Most studies have been based on neurocognitive tests, but scholastic achievement may be a better measure of long-term effects.…”

Academic Difficulties and Occupational Outcomes of Adult Survivors of Childhood Leukemia Who Have Undergone Allogeneic Hematopoietic Stem Cell Transplantation and Fractionated Total Body Irradiation Conditioning

“…Several factors can influence cognitive disorders and school difficulties after leukemia, including especially cerebral radiotherapy dose of 24 grays (Gy) and more [1,2]. Other factors include associated meningeal localization, allogeneic hematopoietic stem cell transplantation (a-HSCT), conditioning of a-HSCT with total body irradiation (TBI) [3], and socioeconomic status.…”

Detection and characterization of neurotoxicity in cancer patients using proton MR spectroscopy

“…Cognitive deficits documented by neuropsychological (NP) testing involve attention and concentration, processing speed, memory, general intelligence, language, and academic achievement [29,26,13]. Risk factors identified from studies of patients with acute lymphoblastic leukemia and brain tumors include young age at treatment [13,23,3,1], dose and type of treatment, particularly cranial irradiation and high-dose chemotherapy [13,15,25], increased time since treatment [26,23], and female gender [3]. Structural changes, including subacute leukoencephalopathy, mineralizing microangiopathy, and cortical atrophy, have been observed on CT or MRI during and after treatment [5], but associations between NP deficits and structural abnormalities are inconsistent and yield mixed results [18,28].…”