The institutions and investigators participating in the CNS Late Effects Study Group are listed in the Appendix.
Article first published online: 22 APR 2002
Copyright © 2002 Wiley-Liss, Inc.
Medical and Pediatric Oncology
Volume 38, Issue 5, pages 320–328, May 2002
How to Cite
Langer, T., Martus, P., Ottensmeier, H., Hertzberg, H., Beck, J. D. and Meier, W. (2002), 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. Med. Pediatr. Oncol., 38: 320–328. doi: 10.1002/mpo.10055
Sections of this paper were presented at Klinische Onkologie 97, 1997, Düsseldorf, Germany, at the 4th International Conference on Long-Term-Complications of Treatment of Children and Adolescents for Cancer, 1996, Buffalo, New York, and at the 91st Jahrestagung der Deutschen Gesellschaft für Kinderheilkunde, 1995, Krefeld, Germany.
This work is carried out by the German Late Effects Study Group.
- Issue published online: 22 APR 2002
- Article first published online: 22 APR 2002
- Manuscript Accepted: 7 OCT 2001
- Manuscript Received: 8 SEP 1999
- Deutsche Krebshilfe
- acute lymphoblastic leukemia;
- cranial irradiation;
- late effects;
- long-term survivors;
To date, the event free survival (EFS) after treatment of childhood acute lymphoblastic leukemia (ALL) attains 80%. The survivor group is growing steadily. Therefore, the primary purpose of our study is to define the neuropsychological function and to describe which central nervous system (CNS) functions are impaired following the German ALL-BFM and COALL protocols for CNS-negative patients.
Patients and Methods
In a cross-sectional multicenter study 121 subjects, long-term survivors of childhood ALL in first continuous complete remission were investigated. Seven years ago, the subjects were treated as standard or medium risk patients according to ALL-BFM 81, ALL-BFM 83, or COALL 82 protocols, receiving comparable treatments. According to different CNS-prophylaxes, two subgroups were compared in the study: the non-cranially irradiated MTX-group (methotrexate-group) (n = 38) and the cranially irradiated RT-group (radiotherapy-group) (with MTX i.th.) (n = 83). Intellectual and cognitive abilities of these groups were evaluated using standardized psychometric techniques. The Kaufman factors Verbal Comprehension, Perceptual Organisation and Freedom from Distractibility were calculated. Demographical and clinical data collected at the time of the diagnosis were compared between both groups. The different prognoses for patients within both groups were taken into account using a defined risk factor. Analysis of variance was conducted to relate intellectual performance to age, gender, and CNS-treatment.
The RT-group exhibited a lower Full Scale IQ than the MTX-group (101.2 ± 15.9 vs. 109.9 ± 14.9, P = 0.031). Particularly for the Kaufman factor Freedom from Distractibility the RT-group showed the lower scores (96.9 ± 14.1 vs. 105.5 ± 12.6, P = 0.037). Significant interactions between gender and CNS prophylactic treatment were observed for Full Scale IQ (P = 0.008), Verbal IQ (P = 0.012), Performance IQ (P = 0.024), Verbal Comprehension (P = 0.004), and Perceptual Organisation (P = 0.032).
Cranial irradiation in combination with MTX therapy was associated with deficits in attention, concentration, and the ability of sequencing and processing, measured by the Kaufman factor Freedom from Distractibility. Our results support the strategy of avoiding prophylactic CNS irradiation in low risk patients. Med. Pediatr. Oncol. 2002;38:320–328. © 2002 Wiley-Liss, Inc.