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Cited by 160Acute Lymphoblastic Leukemia researchChildhood Cancer Survivors' Quality of LifeCancer-related cognitive impairment studies

Longitudinal Assessment of Neurocognitive Outcomes in Survivors of Childhood Acute Lymphoblastic Leukemia Treated on a Contemporary Chemotherapy Protocol

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Jacola, Lisa M., Krull, Kevin R., Pui, Ching-Hon, Pei, Deqing, Cheng, Cheng, Reddick, Wilburn E., Conklin, Heather M.·2016·Journal of Clinical Oncology
DOI 10.1200/jco.2015.64.3205PMC PMC4872325
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Abstract

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.

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  • Neurocognitive and behavioral late effects of childhood ALL treatment include weaknesses in working memory, visual-spatial reasoning, motor coordination, processing speed, and attention.

    “Neurocognitive and behavioral late effects include weaknesses in working memory, visual‐spatial reasoning, motor coordination, processing speed, and attention (Campbell et al., 2009; Iyer, Balsamo, Bracken, & Kadan‐lottick, 2015; Jacola et al., 2016; Peterson et al., 2008).”

    From Brain structure, working memory and response inhibition in childhood leukemia survivors (2017) · cites this paper as Jacola et al., 2016

    The Introduction identifies attention and processing-speed deficits in survivors treated with chemotherapy only, and the Results report attention difficulties and elevated processing-speed risk with higher-intensity treatment. Working memory was assessed, but the paper does not establish the claimed visual-spatial reasoning or motor-coordination weaknesses; its Conclusion says function was largely age appropriate two years after treatment. (LLM, conf=0.87)

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Cited by

Sorted by citations

Authors
Jacola, L. M., Krull, K. R., Pui, C.-H., Pei, D., Cheng, C., Reddick, W. E., & Conklin, H. M.
Affiliations
St. Jude Children's Research Hospital (US)
Corresponding author
Jacola, Lisa M.
ORCID
Venue
Journal of Clinical Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2016-04-10
Volume
34
Issue
11
Pages
1239-1247
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
DOI
10.1200/jco.2015.64.3205
PMC
PMC4872325
OpenAlex
W2272185880
Cited by
160
References
1
Citations by year
2026: 13 · 2025: 12 · 2024: 13 · 2023: 15 · 2022: 16 · 2021: 18 · 2020: 20 · 2019: 11 · 2018: 17 · 2017: 15 · 2016: 9 · 2015: 1
FWCI
17.19
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Oncology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • St. Jude Children's Research Hospital (CA21765)
  • American Lebanese Syrian Associated Charities (GM92666, CA 21765)
  • National Cancer Institute (R01 CA90246, GM92666, CA21765, R01CA090246, P 30CA 21765, P30CA021765)
  • National Institute of General Medical Sciences (U01GM092666, GM 92666)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Acute Lymphoblastic Leukemia research
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords
childhood acute lymphoblastic leukemia, cancer survivors, neuropsychological outcomes, attention deficits, learning difficulties, chemotherapy dose intensity, academic performance, age at diagnosis, sex differences, neurodevelopmental trajectories
MeSH terms
Adolescent, Antineoplastic Combined Chemotherapy Protocols, Attention, Child, Child, Preschool, Cognition, Female, Humans, Infant, Intelligence, Intelligence Tests, Learning, Longitudinal Studies, Male, Memory, Short-Term, Neuropsychological Tests, Predictive Value of Tests, Prospective Studies, Psychomotor Agitation, Task Performance and Analysis, Logistic Models, Survivors, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Young Adult

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