Get access

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

Authors

  • Deborah P. Waber PhD,

    Corresponding author
    1. Division of Psychology, Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts
    2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
    • Department of Psychiatry, Children's Hospital Boston, Pavilion 155, 300 Longwood Avenue, Boston, MA 02115.
    Search for more papers by this author
  • Jennifer Turek Queally PhD,

    1. Division of Psychology, Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts
    2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • Lori Catania PhD,

    1. Division of Psychology, Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts
    2. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • Philippe Robaey MD, PhD,

    1. Department of Psychiatry, Research Center of Ste-Justine Hospital, University of Montreal, Montreal, Canada
    2. Children's Hospital of Eastern Ontario, Ottawa, Canada
    Search for more papers by this author
  • Ivonne Romero PhD,

    1. Inter American University, San Germán, Puerto Rico
    Search for more papers by this author
  • Heather Adams PhD,

    1. Division of Child Neurology, University of Rochester Medical Center, Rochester, New York
    Search for more papers by this author
  • Cheryl Alyman PhD,

    1. Division of Pediatric Hematology/Oncology, McMaster University Medical Center, Hamilton, Ontario, Canada
    Search for more papers by this author
  • Christine Jandet-Brunet MPs,

    1. Division of Psychology, Department of Pediatric Hematology/Oncology, Centre Hospitalier de l'Université Laval de Québec, Quebec, Canada
    Search for more papers by this author
  • Stephen E. Sallan MD,

    1. Division of Hematology and Oncology, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
    2. Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
    3. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author
  • Lewis B. Silverman MD

    1. Division of Hematology and Oncology, Department of Medicine, Children's Hospital Boston, Boston, Massachusetts
    2. Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
    3. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    Search for more papers by this author

  • Conflict of interest: Nothing to declare.

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.

Procedure

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. Pediatr Blood Cancer 2012; 58: 758–765. © 2011 Wiley Periodicals, Inc.

Ancillary