title: Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review.
abstract: The intensified administration of chemotherapeutic drugs has gradually replaced cranial radiation therapy (CRT) for the treatment of childhood acute lymphoblastic leukemia (ALL). While CRT is often implicated in neurocognitive impairment in ALL survivors, there is a paucity of the literature that evaluates the persistence of neurocognitive deficits in long-term survivors of pediatric ALL who were treated with contemporary chemotherapy-only protocols. Results from this systematic review concurred to the probable cognitive-sparing effect of chemotherapy-based protocols over CRT in long-term survivors. However, coupled with multiple intrinsic and extrinsic factors, survivors who received chemotherapy treatment still suffered from apparent cognitive impairment, particularly in the attention and executive function domains. Notably, there is evidence to suggest that the late neurotoxic effect of methotrexate on survivors' neurocognitive performance may be dose-related. This review also recommends future pharmacokinetic, neuroimaging and genetic studies to illuminate the multifactorial nature of this subject matter and discusses the potential value of neurochemical, physiological, inflammatory and genetic markers for the prediction of susceptibility to neurocognitive impairment in long-term survivors of childhood ALL.
authors: Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA.
authors: Yin Ting
authors: YT
authors: Cheung
authors: Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA. Electronic address: kevin.krull@stjude.org.
authors: Kevin R
authors: KR
authors: Krull
mesh_terms: D006801:Humans; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000523:psychology; D017741:Survivors / Q000523:psychology; D002985:Clinical Protocols
chemical_list: D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D008727:Methotrexate
keywords: Acute lymphoblastic leukemia; Cancer survivorship; Chemotherapy; Neurocognitive; Pediatric cancer