Among children with acute lymphoblastic leukemia (ALL), treatment of the central nervous system with chemotherapy rather than cranial radiation therapy appears to result in higher measures of intelligence, academic achievement, and memory. These results were published in the Journal of Clinical Oncology.
Acute lymphoblastic leukemia is a malignant disease or cancer of the blood characterized by the rapid uncontrolled growth of abnormal, immature white blood cells known as lymphoblasts. Acute lymphoblastic leukemia is the most common leukemia in children, with approximately 2,400 new patients diagnosed each year in the United States.
In children with ALL, the central nervous system (CNS)-the brain and spinal column-is a common site of cancer recurrence. To reduce the risk of a CNS recurrence, treatment of childhood ALL generally includes CNS-directed therapies. These therapies may include chemotherapy or cranial radiation therapy.
A concern with the use of cranial radiation therapy is that it adversely affects several aspects of learning and thinking, including general intelligence, attention, and processing speed. The effects of CNS-directed chemotherapy are less well understood.
To describe neurocognitive outcomes in children with ALL, researchers conducted a study among 79 children diagnosed with high-risk ALL between the ages of 1 and 5 years. CNS-directed therapy included intrathecal chemotherapy (chemotherapy administered into the cerebrospinal fluid) as well as one of the following additional treatments: high-dose intravenous methotrexate, very high-dose intravenous methotrexate, or cranial radiation therapy.
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The neurocognitive assessment included tests that measured intelligence, academic achievement, attention, and memory.
- Children treated with high-dose or very high-dose intravenous methotrexate had levels of neurocognitive function that were similar to children in the general population.
- Children treated with cranial radiation therapy had lower scores on most measures of neurocognitive function.
The researchers conclude that children with ALL who do not receive cranial radiation therapy have good long-term neurocognitive outcomes.
Reference: Spiegler BJ, Kennedy K, Maze R et al. Comparison of Long-term Neurocognitive Outcomes in Young Children with Acute Lymphoblastic Leukemia Treated with Cranial Irradiation or High-dose or Very High-dose Intravenous Methotrexate. Journal of Clinical Oncology. 2006;24:3858-3864.
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