Visual and Verbal Short-Term Memory Deficits in Childhood Leukemia Survivors After Intrathecal Chemotheraphy

Hill, Dina E.; Ciesielski, Kristina T.; Sethre-Hofstad, Lisa; Duncan, Mark; Lorenzi, Marguerite

doi:10.1093/jpepsy/22.6.861

Cited by 59 publications

(53 citation statements)

References 20 publications

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“…Even though the poor prognostic impact of traumatic lumbar puncture can be abolished by intensive systemic and intrathecal therapy, 15 every effort should be made to prevent its occurrence because intrathecal therapy can also adversely affect neuropsychologic and spinal cord functions. 32,33 Since recognition of the adverse consequences of traumatic lumbar puncture, 34 we correct thrombocytopenia before the diagnostic lumbar puncture, which is followed immediately by intrathecal treatment. Finally, intrathecal therapy is routinely performed by the most experienced clinician in our center, with patients under deep sedation or general anesthesia.…”

Section: Intrathecal Therapymentioning

confidence: 99%

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Pui

2006

Hematology

105

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Improved treatment for acute lymphoblastic leukemia (ALL) has virtually eliminated testicular relapse. However, the control of central nervous system (CNS) leukemia remains a therapeutic challenge in childhood ALL, partly because of the late complications arising from cranial irradiation. In most current pediatric protocols, cranial irradiation (12 to 18 Gy) is given to 5% to 25% of patients—those with T-cell ALL, overt CNS disease (CNS3 status) or high-risk cytogenetics. CNS control is a less urgent concern in adults with ALL, in whom systemic relapse remains the major problem. With current approaches, approximately 2% to 10% of patients can be expected to develop CNS relapse. Children with B-cell precursor ALL who have a late CNS relapse (after an initial remission of 18 months or more) and did not receive cranial irradiation have an excellent outcome after retrieval therapy, with a 5-year event-free survival (EFS) rate approaching that in newly diagnosed patients. Innovative treatment options are needed for children who develop CNS relapses after a short initial remission or after receiving cranial irradiation, and in any adults with CNS leukemia at diagnosis or relapse.

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Section: Intrathecal Therapymentioning

confidence: 99%

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Pui

2006

Hematology

105

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“…Six of the studies conclusively showed that ALL survivors experienced deficits in neurocognitive functioning when compared with age-matched healthy controls (Table 1), which was attributed to their chemotherapy-only treatment. 19,28,[31][32][33] The other 4 studies found either very small differences or differences that were not statistically significant when compared with the healthy control group. Intelligence or overall cognitive ability was measured by 8 studies.…”

mentioning

confidence: 94%

“…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).…”

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confidence: 99%

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

Iyer

Balsamo

Bracken

et al. 2015

Blood

160

132

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• Children treated for ALL without cranial radiation display significant IQ deficits of 6 to 8 points compared with healthy controls.• Moderate deficits occur in other neurocognitive domains including working memory, information processing speed, and fine motor functioning.Therapy for childhood acute lymphoblastic leukemia (ALL) is associated with 5-year survival rates of ∼90% even after largely eliminating cranial radiation. This meta-analysis assesses the long-term neurocognitive functioning after chemotherapy-only regimens among survivors of childhood ALL. We conducted a systematic review to identify studies that evaluated long-term neurocognitive functioning following treatment of ALL by searching MEDLINE/PubMed, Database of Abstracts of Reviews of Effects, and secondary sources. Studies were included if ALL survivors were in continuous first remission, did not receive any radiation, were at least ‡2 years off therapy or ‡5 years since diagnosis, and were compared with a healthy control group. Weighted mean differences with 95% confidence intervals (CIs) were calculated. Ten nonexperimental studies met all eligibility criteria and included 509 patients and 555 controls. Meta-analysis demonstrated statistically significant moderate impairment across multiple neurocognitive domains evaluated, with intelligence most affected. Significant differences in standard deviation (SD) scores were found for Full Scale intelligence quotient (IQ) (20.52 SD; 95% CI, 20.68 to 20.37), Verbal IQ (20.54 SD; 95% CI, 20.69 to 20.40), and Performance IQ (20.41 SD; 95% CI, 20.56 to 20.27); these SD scores correspond to changes in IQ of 6 to 8 points. Working memory, information processing speed, and fine motor domains were moderately, but statistically significantly, impaired. Meta-analysis of ALL survivors treated without cranial radiation demonstrated significant impairment in IQ and other neurocognitive domains. Patients and their families should be informed about these potential negative effects to encourage surveillance and educational planning. Both preventive and intervention strategies are needed. (Blood. 2015;126(3):346-353) IntroductionAcute lymphoblastic leukemia (ALL) is the most common malignancy in children, accounting for 18% of all cancers and 74% of all leukemias.1 As a result of improvements in treatment and supportive care over recent decades, the current 5-year relative survival rate is 89% for children diagnosed with ALL before age 20 years 1 and exceeds 93% for children with standard risk features diagnosed before age 10 years.2 Because the vast majority of children with ALL are expected to survive their disease, it is important to understand the long-term burden of therapy.Neurocognitive and psychological difficulties as a result of chemotherapy have been documented in survivors of adult cancer across a variety of cancer types.3 However, most pediatric studies have focused on children with brain tumors or central nervous system (CNS)-directed radiation treatment. 4 Although the deleterious neurocognitive ...

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“…7,13 In addition, long-term difficulties in cognitive and academic function are often described, 22 most frequently visual perceptual, attention, and math skills. 10,13,[23][24][25][26][27][28][29][30][31][32][33][34][35] Voxel-based morphometry (VBM) is an automated method for analyzing whole brain regional differences on a voxel-by-voxel basis. The purpose of this study was to use VBM to examine regional white and gray matter differences in a group of long-term survivors of ALL treated with systemic and intrathecal chemotherapy, compared with a group of healthy controls, and to examine the relationship of regional brain volumes to cognitive function.…”

mentioning

confidence: 99%

Reduced Frontal White Matter Volume in Long-Term Childhood Leukemia Survivors: A Voxel-Based Morphometry Study

Carey¹,

Haut²,

Reminger³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:To our knowledge, no published studies have examined whole-brain regional differences to identify more discrete volumetric changes in the brains of childhood leukemia survivors. We used voxel-based morphometry (VBM) to examine regional gray and white matter differences in a group of long-term survivors of acute lymphoblastic leukemia (ALL) compared with a group of healthy controls. Differences in regional white matter volume were expected, given previous reports of white matter changes during treatment for ALL and reduced brain white matter volumes in long-term survivors. Follow-up analyses examined the relationship of regional brain volumes to cognitive function.

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Visual and Verbal Short-Term Memory Deficits in Childhood Leukemia Survivors After Intrathecal Chemotheraphy

Cited by 59 publications

References 20 publications

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

Central Nervous System Disease in Acute Lymphoblastic Leukemia: Prophylaxis and Treatment

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

Reduced Frontal White Matter Volume in Long-Term Childhood Leukemia Survivors: A Voxel-Based Morphometry Study

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