title: Neuropsychological outcomes of standard risk and high risk patients treated for acute lymphoblastic leukemia on Dana-Farber ALL consortium protocol 95-01 at 5 years post-diagnosis.
abstract: BACKGROUND
  Children treated for acute lymphoblastic leukemia (ALL) as High Risk (HR) patients may be more vulnerable to neurocognitive late effects because of the greater intensity of their therapy. We compared neuropsychological outcomes in children treated for Standard Risk (SR) or HR ALL on Dana-Farber Cancer Institute (DFCI) Consortium ALL Protocol 95-01. We also evaluated their performance relative to normative expectations.
  
  
  METHODS
  Between 1996 and 2000, 498 children with newly diagnosed ALL were treated on Protocol 95-01, 298 of whom were eligible for neuropsychological follow-up. A feature of this protocol was modification of risk group criteria to treat more children as SR rather than HR patients, intended to minimize toxicities. Testing was completed at a median of 5.3 years post-diagnosis for 211 patients (70.8%; ages 6-25 years; 45.5% male; 40% HR), all of whom were in continuous complete remission.
  
  
  RESULTS
  Test scores for both groups were generally at or above normative expectation, with the exception of verbal working memory, processing complex visual information, and parent ratings of metacognitive skills. After adjusting for covariates, the SR group performed better on measures of IQ and academic achievement, working memory and visual learning. Effect sizes, however, were only in the small to moderate range.
  
  
  CONCLUSIONS
  HR patients exhibited neuropsychological deficits relative to SR patients, though the differences were modest in degree. Modification of the risk group criteria to treat more children on the SR protocol therefore likely afforded some benefit in terms of neurocognitive late effects.
authors: Division of Psychology, Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts 02115, USA. deborah.waber@childrens.harvard.edu
authors: Deborah P
authors: DP
authors: Waber
authors: Jennifer Turek
authors: JT
authors: Queally
authors: Lori
authors: L
authors: Catania
authors: Philippe
authors: P
authors: Robaey
authors: Ivonne
authors: I
authors: Romero
authors: Heather
authors: H
authors: Adams
authors: Cheryl
authors: C
authors: Alyman
authors: Christine
authors: C
authors: Jandet-Brunet
authors: Stephen E
authors: SE
authors: Sallan
authors: Lewis B
authors: LB
authors: Silverman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000523:psychology; D012044:Regression Analysis; D012306:Risk