title: Neurologic morbidity and quality of life in survivors of childhood acute lymphoblastic leukemia: a prospective cross-sectional study.
abstract: OBJECTIVE
  Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs and neurologic complications in long-term survivors are inadequately studied. This study investigated neurologic morbidity and its effect on quality of life in long-term survivors of childhood ALL.
  
  
  METHODS
  Prospective, single institution, cross-sectional, institutional review board-approved study of long-term ALL survivors. Participants were recruited from institutional clinics. Participants answered an investigator-administered questionnaire followed by evaluation by a neurologist. Quality of life (QOL) was also assessed.
  
  
  RESULTS
  Of the 162 participants recruited over a 3-year period, 83.3% reported at least one neurologic symptom of interest, 16.7% had single symptom, 11.1% had two symptoms, and 55.6% had three or more symptoms. Symptoms were mild and disability was low in the majority of participants with neurologic symptoms. Median age at ALL diagnosis was 3.9 years (0.4-18.6), median age at study enrollment was 15.7 years (6.9-28.9), and median time from completion of ALL therapy was 7.4 years (1.9-20.3). On multivariable analyses, female sex correlated with presence of dizziness, urinary incontinence, constipation, and neuropathy; use of ≥10 doses of triple intrathecal chemotherapy correlated with urinary incontinence, back pain, and neuropathy; cranial radiation with ataxia; history of ALL relapse with fatigue; and CNS leukemia at diagnosis with seizures. Decline in mental QOL was associated with migraine and tension type headaches, while physical QOL was impaired by presence of dizziness and falls. Overall, good QOL and physical function was maintained by a majority of participants.
  
  
  CONCLUSIONS
  Neurologic symptoms were present in 83% long-term ALL survivors. Symptoms related morbidity and QOL impairment is low in majority of survivors. Female sex, ≥10 doses of intrathecal chemotherapy, and history of ALL relapse predispose to impaired QOL.
  
  
  CONCLUSIONS
  This study will educate survivors and their care providers regarding cancer or treatment-related neurologic symptoms and morbidity. This study will help them understand factors contributing to impaired QOL when present.
authors.affiliation: Division of Neurology, St. Jude Children's Research Hospital, Mail stop 220, Memphis, TN, 38015, USA, raja.khan@stjude.org.
authors.forename: Raja B
authors.initials: RB
authors.lastname: Khan
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Davonna S
authors.initials: DS
authors.lastname: Ledet
authors.forename: E Brannon
authors.initials: EB
authors.lastname: Morris
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
authors.forename: Debbie
authors.initials: D
authors.lastname: Crom
authors.forename: Emily
authors.initials: E
authors.lastname: Browne
authors.forename: Liang
authors.initials: L
authors.lastname: Zhu
authors.forename: Shesh
authors.initials: S
authors.lastname: Rai
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
mesh_terms: D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality*; D011446:Prospective Studies; D011788:Quality of Life; D017741:Survivors