CNS late‐effects after ALL therapy in childhood. Part III: Neuropsychological performance in long‐term survivors of childhood ALL: Impairments of concentration, attention, and memory*†‡

Langer, Thorsten; Martus, Peter; Ottensmeier, Holger; Hertzberg, Holger; Beck, J. D.; Meier, W

doi:10.1002/mpo.10055

Cited by 164 publications

(120 citation statements)

References 51 publications

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“…However, an internal comparison did not reach significance, which could be due to the analyses being based on small numbers in relation to this rather infrequent event. The finding that male survivors of CNS tumours had a reduced chance of completing basic education probably reflects the well-known risk for neuropsychological sequelae after cranial radiotherapy (Lannering et al, 1990;Jankovic et al, 1994;Langer et al, 2002;Reimers et al, 2003) and the subsequent learning difficulties, which cannot be compensated fully by special educational programmes (Peckham, 1991;Haupt et al, 1994;Dongen-Melman et al, 1997;Mitby et al, 2003). The finding that female survivors of CNS tumours had a reduced chance of attaining education at most levels may support the suggestion that the developing female brain is more vulnerable to cranial radiation (Schlieper et al, 1989;Bleyer et al, 1990).…”

Section: Discussionmentioning

confidence: 83%

Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark

et al. 2004

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We identified 2384 patients in the Danish Cancer Register in whom cancer had been diagnosed in 1960 -1996 before they reached the age of 20 and compared them with 53 143 sex-and age-matched controls identified from the Register of Population Statistics. Complete education records and demographic and socioeconomic information for the period 1980 -2000 were obtained for both cohorts from Statistics Denmark. The rate ratio (RR) for educational attainment was estimated by discrete-time Cox regression analyses. An overall reduction in attaining basic education was found (RR, 0.90; 95% confidence interval, 0.83 -0.96). Female survivors of central nervous system (CNS) tumours showed the largest educational deficit (RR, 0.55; 95% confidence interval, 0.37 -0.82). Non-CNS tumour survivors attained education as controls at most levels. When the analyses were conditioned on completion of youth education, further educational attainment was not reduced for any group of survivors. These findings confirm that only survivors of CNS tumours in childhood experience significant educational deficits. The deficit was mainly seen among persons whose tumour was diagnosed before they reached the level of secondary education.

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Section: Discussionmentioning

confidence: 83%

Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark

et al. 2004

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“…22 However, in a larger study of 121 patients with ALL, cumulative IT dose did not predict cognitive functioning. 23 Among all children who participated in the randomized, controlled study (N ϭ 1,018), grades 3 to 4 CNS toxicity on therapy, as reported by treating physicians, occurred in 5.8% on IT methotrexate and in 6.7% of those on triple IT therapy. 8 In our cross-sectional sample, parents of patients reported a higher frequency of acute CNS toxic events of any severity during therapy in the IT methotrexate group.…”

Section: ‫ء‬mentioning

confidence: 99%

Comparison of Neurocognitive Functioning in Children Previously Randomly Assigned to Intrathecal Methotrexate Compared With Triple Intrathecal Therapy for the Treatment of Childhood Acute Lymphoblastic Leukemia

Kadan‐Lottick

Brouwers

Breiger

et al. 2009

JCO

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Purpose For the majority of children with acute lymphoblastic leukemia (ALL), CNS prophylaxis consists of either intrathecal (IT) methotrexate or triple IT therapy (ie, methotrexate with both cytarabine and hydrocortisone). The long-term neurotoxicities of these two IT strategies have not yet been directly compared. Patients and Methods In this multisite study, 171 children with standard-risk ALL, age 1 to 9.99 years at diagnosis, previously randomly assigned to IT methotrexate (n = 82) or to triple IT therapy (n = 89) on CCG 1952, underwent neurocognitive evaluation by a licensed psychologist at a mean of 5.9 years after random assignment. Results Patients who received IT methotrexate had a mean Processing Speed Index that was 3.6 points lower, about one fourth of a standard deviation, than those who received triple IT therapy (P = .04) after analysis was adjusted for age, sex, and time since diagnosis. Likewise, 19.5% of children in the IT methotrexate group had a Processing Speed Index score in the below-average range compared with 6.9% in the triple IT therapy group (P = .02). Otherwise, the groups performed similarly on tests of full-scale intelligence quotient, academic achievement, attention/concentration, memory, and visual motor integration. The association of treatment with measures of cognitive functioning was not modified by sex or age at diagnosis. In the post-therapy period, there were no group differences in special education services, neurologic events, or use of psychotropic medications. Conclusion This study did not show any clinically meaningful differences in neurocognitive functioning between patients previously randomly assigned to IT methotrexate or triple IT therapy except for a small difference in processing speed in the IT methotrexate group.

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“…Th e authors of clinical studies indicate that females have a higher risk of neurocognitive complications aft er therapy ALL [26][27][28], which was not the case in this study-complications were equally represented and in male and female patients. According to the results of other authors, dexamethasone more often causes psychiatric disorders compared to prednisone, primarily due to the greater liposolubility which increased the crossing of blood-brain barrier [29].…”

Section: Discussionmentioning

confidence: 47%

Safety and tolerability of high doses of glucocorticoides

Rakić¹,

Kolarovic²,

Konstantinidis³

et al. 2016

Hosp Pharm Int Multi J

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SUMMARYIntroduction: Treatment of acute lymphoblastic leukemia includes the use of high doses of glucocorticoides (prednisone and dexamethasone), which signifi cantly increase the success of therapy due to lymphocytolitic eff ect. The aim: The aim of the study was to determine tolerability of high doses of prednisone and dexamethasone in children with acute lymphoblastic leukemia and the structure and the intensity of adverse eff ects, occurred after application of these medicines. Subjects and methods:In a prospective study, we analyzed adverse eff ects of high doses of glucocorticoides in children suff ering acute lymphoblastic leukemia treated in the Institute for Child and Youth Health Care of Vojvodina, since December 2010. until October 2014, were analyzed. This study included 18 patients, aged from 2 to 15 years. Results: Hyperglycemia appeared in 89% of patients treated with prednisone and in 61% of patients treated with dexamethasone. In order to control the high blood glucose level (above 10 mmol /L), in 11% of patients insulin was used. Hypertension appeared in 28% patients treated with prednisone and dexamethasone. Antihypertensives were needed for regulation in 17% patients. Hypopotassemia and hypocalcaemia were signifi cantly more expressed after the use of prednisone in comparison to dexamethasone. In 11% of patients, the treatment with dexamethasone caused depressive behavior, followed by agitation. Conclusion: Adverse eff ects of dexamethasone and prednisone, administered in high doses in children with ALL were known, expected and reversible. Adverse reactions usually disappeared spontaneously or after short-term symptomatic therapy.

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CNS late‐effects after ALL therapy in childhood. Part III: Neuropsychological performance in long‐term survivors of childhood ALL: Impairments of concentration, attention, and memory*†‡

Cited by 164 publications

References 51 publications

Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark

Educational attainment among survivors of childhood cancer: a population-based cohort study in Denmark

Comparison of Neurocognitive Functioning in Children Previously Randomly Assigned to Intrathecal Methotrexate Compared With Triple Intrathecal Therapy for the Treatment of Childhood Acute Lymphoblastic Leukemia

Safety and tolerability of high doses of glucocorticoides

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