Cognitive outcomes following contemporary treatment without cranial irradiation for childhood acute lymphoblastic leukemia.
Background: Treatment of acute lymphoblastic leukemia (ALL) has included the use of prophylactic cranial irradiation in up to 20% of children with high-risk disease despite known cognitive risks of this treatment modality.Methods: Patients enrolled on the St Jude ALL Total Therapy Study XV, which om...
| Publicado en: | JNCI: Journal of the National Cancer Institute Vol. 104; no. 18; pp. 1386 - 1396 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Oxford University Press / USA
9/19/2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104368859&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104368859 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00278874 JNC jtl: JNCI: Journal of the National Cancer Institute issn: 00278874 maglogo: N pubinfo: dt: 9/19/2012 vid: 104 iid: 18 pid: 622 pub: Oxford University Press / USA artinfo: ui: 104368859 104368859 NLM22927505 2011689897 NLM22927505 PMC3529594 104368859 ppf: 1386 ppct: 10 formats: tig: atl: Cognitive outcomes following contemporary treatment without cranial irradiation for childhood acute lymphoblastic leukemia. aug: au: Conklin HM Krull KR Reddick WE Pei D Cheng C Pui CH Conklin, H M Krull, K R Reddick, W E Pei, D Cheng, C Pui, C H affil: Department of Psychology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-2794, USA sug: subj: Antineoplastic Agents, Combined Administration and Dosage Antineoplastic Agents, Combined Adverse Effects Attention Drug Effects Cognition Drug Effects Intelligence Drug Effects Leukemia, Lymphocytic, Acute Drug Therapy Leukemia, Lymphocytic, Acute Psychosocial Factors 6-Mercaptopurine Administration and Dosage 6-Mercaptopurine Adverse Effects Adolescence Age Factors Child Child, Preschool Cytarabine Administration and Dosage Cytarabine Adverse Effects Dexamethasone Administration and Dosage Dexamethasone Adverse Effects Disease Remission Drug Administration Schedule Female Human Hydrocortisone Administration and Dosage Hydrocortisone Adverse Effects Infant Injections, Intraspinal Intelligence Tests Logistic Regression Male Methotrexate Administration and Dosage Methotrexate Adverse Effects Multivariate Analysis Patient Selection Prednisone Administration and Dosage Prednisone Adverse Effects Radiotherapy Adverse Effects Risk Factors Sex Factors Time Factors Treatment Outcomes Vincristine Administration and Dosage Vincristine Adverse Effects Adolescent: 13-18 years Child: 6-12 years Child, Preschool: 2-5 years Infant: 1-23 months Female Male ab: Background: Treatment of acute lymphoblastic leukemia (ALL) has included the use of prophylactic cranial irradiation in up to 20% of children with high-risk disease despite known cognitive risks of this treatment modality.Methods: Patients enrolled on the St Jude ALL Total Therapy Study XV, which omitted prophylactic cranial irradiation in all patients, were assessed 120 weeks after completion of consolidation therapy (n = 243) using a comprehensive cognitive battery. χ(2) analysis was used to compare the percentage of below-average performers among the entire ALL patient group to the expected rate based on the normative sample. Univariate logistic regression was used to estimate the effect of intensity of chemotherapy (treatment arm), age at diagnosis, and sex on the probability of below-average performance. All statistical tests were two-sided.Results: Overall, the ALL group had a statistically significantly higher risk for below-average performance on a measure of sustained attention (67.31% more than 1 SD below the normative mean for omission errors, P < .001) but not on measures of intellectual functioning, academic skills, or memory. Patients given higher intensity chemotherapy were at greater risk for below-average performance compared with those given lower intensity therapy on measures of processing speed (27.14% vs 6.25%, P = .009) and academic abilities (Math Reasoning: 18.60% vs 3.90%, P = .008; Word Reading: 20.00% vs 2.60%, P = .007; Spelling: 27.91% vs 3.90%, P = .001) and had higher parent-reported hyperactivity (23.00% vs 9.84%, P = .018) and learning problems (35.00% vs 16.39%, P = .005). Neither age at diagnosis nor sex was associated with risk for below-average cognitive performance.Conclusions: Omitting cranial irradiation may help preserve global cognitive abilities, but treatment with chemotherapy alone is not without risks. Caregiver education and development of interventions should address both early attention deficits and cognitive late effects. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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