Progressive neurocognitive impairment in young adult survivors of childhood acute lymphoblastic leukemia

Abstract

Survivors of childhood ALL suffer from long-lasting progressive neuropsychological impairment, especially when treatment includes cranial irradiation.

Chemotherapy-only treatment effects on long-term neurocognitive functioning in childhood ALL survivors: a review and meta-analysis

“…Of the 42 studies, 13 were excluded because patients were less than 5 years since diagnosis or 2 years since the end of treatment, 8 because they lacked a healthy control group, 6 because some/all patients received cranial radiation, and 5 because they did not directly assess neurocognitive outcomes of interest (summarized in Figure 1). Ten studies 11,19,[26][27][28][29][30][31][32][33][34] remained that met all the predefined inclusion criteria (Table 1).…”

“…Four studies evaluated verbal memory, the ability to encode and retrieve verbally presented information, 11,27,28,30 Only 2 of the studies found diminished verbal memory functioning in the ALL survivor group compared with the healthy control group.…”

“…Three studies evaluated fine motor functioning, 11,27,30 all with the same version of the Purdue Pegboard test, with a total sample of 57 ALL survivors and 270 healthy controls. Using weighted mean differences, the pooled effect estimate (Figure 7) showed that the ALL group performed worse (SD, 20.69; 95% CI, 21.28 to 20.11) than the healthy control group (P 5 .02).…”

“…Six of the 10 studies used a cross-sectional design, identified participants at some point after remission was established, and conducted at least 1 neurocognitive assessment after completion of treatment. 27,28,[31][32][33][34] The other 4 studies used a longitudinal design, identified patients at diagnosis, and completed periodic neurocognitive assessments during treatment and off therapy. 11,19,29,30 Collectively, the study population included in the analyses had a mean age at diagnosis of 4.4 years (median, 4.0), a mean age at last evaluation of 11.7 years (median, 10.3), and a mean time since diagnosis of 8.0 years (median, 8.2).…”

Excellent response to dasatinib of childhood Philadelphia positive intracranial acute lymphoblastic leukaemia tumours

“…There is a clear role for emergent cranial radiation therapy in moribund patients with bulky CNS disease at presentation (Cuvelier et al, 2008). However cranial radiation therapy for childhood ALL is associated with an increased risk of neurocognitive deficits, particularly in younger children, which may be progressive (Spiegler et al, 2006;Harila et al, 2009). There is recent data supporting the use of dasatinib for Ph+ CNS disease (Porkka et al, 2008), and the introduction of dasatinib and intensive induction therapy led to rapid regression of bulky intracranial disease and steady neurological recovery in both cases.…”