Longitudinal Assessment of Neurocognitive Outcomes in Survivors of Childhood Acute Lymphoblastic Leukemia Treated on a Contemporary Chemotherapy Protocol.
Purpose: Survivors of childhood acute lymphoblastic leukemia (ALL) treated with CNS-directed chemotherapy are at risk for neurocognitive deficits. Prospective longitudinal studies are needed to clarify the neurodevelopmental trajectory in this vulnerable population. Methods: Patients enrolled in the...
| Publicado en: | Journal of Clinical Oncology Vol. 34; no. 11; pp. 1239 - 1248 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
American Society of Clinical Oncology
4/10/2016
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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=114335645&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 114335645 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0732183X 20D jtl: Journal of Clinical Oncology issn: 0732183X maglogo: N pubinfo: dt: 4/10/2016 vid: 34 iid: 11 pid: 26892 pub: American Society of Clinical Oncology place: Alexandria, Virginia artinfo: ui: 114335645 114335645 NLM26858334 114335645 10.1200/JCO.2015.64.3205 NLM26858334 PMC4872325 [Available on 02/10/17] 114335645 ppf: 1239 ppct: 9 formats: tig: atl: Longitudinal Assessment of Neurocognitive Outcomes in Survivors of Childhood Acute Lymphoblastic Leukemia Treated on a Contemporary Chemotherapy Protocol. aug: au: Jacola, Lisa M. Krull, Kevin R. Ching-Hon Pui Deqing Pei Cheng Cheng Reddick, Wilburn E. Conklin, Heather M. Pui, Ching-Hon Pei, Deqing Cheng, Cheng affil: St. Jude Children's Research Hospital, Memphis TN sug: subj: Cognition Drug Effects Antineoplastic Agents, Combined Adverse Effects Leukemia, Lymphocytic, Acute Psychosocial Factors Leukemia, Lymphocytic, Acute Drug Therapy Attention Drug Effects Child Prospective Studies Child, Preschool Human Young Adult Neuropsychological Tests Intelligence Tests Learning Drug Effects Survivors Psychomotor Agitation Epidemiology Logistic Regression Infant Female Intelligence Drug Effects Memory, Short Term Drug Effects Predictive Value of Tests Leukemia, Lymphocytic, Acute Physiopathology Adolescence Male Task Performance and Analysis Antineoplastic Agents, Combined Administration and Dosage Validation Studies Comparative Studies Evaluation Research Multicenter Studies Child: 6-12 years Child, Preschool: 2-5 years Infant: 1-23 months Adolescent: 13-18 years Female Male ab: Purpose: Survivors of childhood acute lymphoblastic leukemia (ALL) treated with CNS-directed chemotherapy are at risk for neurocognitive deficits. Prospective longitudinal studies are needed to clarify the neurodevelopmental trajectory in this vulnerable population. Methods: Patients enrolled in the St. Jude Total Therapy Study XV, which omitted prophylactic cranial radiation therapy in all patients, completed comprehensive neuropsychological assessments at induction (n = 142), end of maintenance (n = 243), and 2 years after completion of therapy (n = 211). We report on longitudinal change in neurocognitive function and predictors of neurocognitive outcomes 2 years after completing therapy. Results: Neurocognitive function was largely age appropriate 2 years after completing therapy; however, the overall group demonstrated significant attention deficits and a significantly greater frequency of learning problems as compared with national normative data (all P ≤ .005). Higher-intensity CNS-directed chemotherapy conferred elevated risk for difficulties in attention, processing speed, and academics (all P ≤ .01). The rate and direction of change in performance and caregiver-reported attention difficulties differed significantly by age at diagnosis and sex. End-of-therapy attention problems predicted lower academic scores 2 years later, with small to moderate effect sizes (│r│= 0.17 to 0.25, all P ≤ .05). Conclusion: Two years after chemotherapy-only treatment, neurocognitive function is largely age appropriate. Nonetheless, survivors remain at elevated risk for attention problems that impact real-world functioning. Attention problems at the end of therapy predicted decreased academics 2 years later, suggesting an amplified functional impact of discrete neurocognitive difficulties. Age at diagnosis and patient sex may alter neurocognitive development in survivors of childhood ALL treated with chemotherapy-only protocols. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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