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Cognitive Changes in Children Treated for Acute Lymphoblastic Leukemia With Chemotherapy Only According to the Pediatric Oncology Group 9605 Protocol

Oncology/Medical Day Patient Service Unit, Children's Hospital of Eastern Ontario

Sally M. Kuehn, PhD, C Psych

Mental Health Patient Service Unit, Discipline of Psychology, Children's Hospital of Eastern Ontario

Daniel L. Keene, MD

Department of Pediatrics, Division of Neurology, Children's Hospital of Eastern Ontario

Nicholas J. Barrowman, PhD

Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON

Elizabeth Hsu, MD

Department of Pediatrics, Division of Hematology/Oncology

Mary-Ann Matzinger, MD

Department of Diagnostic Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON

Hal Dunlap, MD

Department of Diagnostic Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON

Jacqueline M. Halton, MD

Department of Pediatrics, Division of Hematology/Oncology montour{at}cheo.on.ca.

The purpose of this study was to examine cognitive functioning and neuroimaging in children with leukemia treated with the Pediatric Oncology Group 9605 protocol at the Children's Hospital of Eastern Ontario. Mean age at diagnosis was 4.88 ± 2.54 years. The mean (n = 24) Wechsler Verbal and Performance IQ fell in the low-average range (87.33 ± 15.69 and 84.83 ± 19.11, respectively). Mean (n = 20) Verbal and Visual Memory Indexes of 82.95 ± 15.46 and 88.30± 10.80, respectively, were obtained. The proportion of scores on measures of intelligence and memory falling > 1 SD below the normative mean was substantially higher than expected. Paired t-test suggested that Wechsler Verbal IQ and memory remained stable, whereas Wechsler Performance IQ declined significantly. The results of growth curve analyses replicated these findings and suggested a significant adverse effect of cumulative dosage of intrathecal methotrexate on estimated Wechsler Performance IQ. Although only two children experienced seizures, 78% of the group showed leukoencephalopathy on at least one magnetic resonance image. Reliance on seizures as a predictor of leukoencephalopathy might underestimate the incidence of neurotoxicity. (J Child Neurol 2005;20:129—133).

Journal of Child Neurology, Vol. 20, No. 2, 129-133 (2005)
DOI: 10.1177/08830738050200020901


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