Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1994 Apr;70(4):275–280. doi: 10.1136/adc.70.4.275

Neuropsychological and neurological outcome after relapse of lymphoblastic leukaemia.

D Christie 1, M Battin 1, A D Leiper 1, J Chessells 1, F Vargha-Khadem 1, B G Neville 1
PMCID: PMC1029777  PMID: 7514391

Abstract

Fourteen children who relapsed after initial remission of leukaemia were studied. Six received a second course of cranial radiotherapy, while the remaining eight children were given total body irradiation before bone marrow transplantation. The postirradiation somnolence syndrome was common after cranial radiotherapy. All children had mild/soft neurological signs, mostly of coordination. None had a major motor disability. All but the youngest child had cataracts; two children required an operation for these. All children were growth hormone deficient. Verbal IQ, attention, and concentration were selectively reduced (with respect to normative levels). The time between the two treatments, age at relapse, and higher doses of radiotherapy all correlated with cognitive outcome, with girls showing greater impairments than boys. Only two children were performing at age appropriate levels on measures of academic achievement. It is concluded that neurological and neuropsychological morbidity is significantly increased by the current treatments prescribed after the relapse of leukaemia.

Full text

PDF
275

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aur R. J., Simone J., Hustu H. O., Walters T., Borella L., Pratt C., Pinkel D. Central nervous system therapy and combination chemotherapy of childhood lymphocytic leukemia. Blood. 1971 Mar;37(3):272–281. [PubMed] [Google Scholar]
  2. Brouwers P., Riccardi R., Poplack D., Fedio P. Attentional deficits in long-term survivors of childhood acute lymphoblastic leukemia (ALL). J Clin Neuropsychol. 1984 Aug;6(3):325–336. doi: 10.1080/01688638408401222. [DOI] [PubMed] [Google Scholar]
  3. Chessells J. M., Cox T. C., Kendall B., Cavanagh N. P., Jannoun L., Richards S. Neurotoxicity in lymphoblastic leukaemia: comparison of oral and intramuscular methotrexate and two doses of radiation. Arch Dis Child. 1990 Apr;65(4):416–422. doi: 10.1136/adc.65.4.416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Copeland D. R., Dowell R. E., Jr, Fletcher J. M., Sullivan M. P., Jaffe N., Cangir A., Frankel L. S., Judd B. W. Neuropsychological test performance of pediatric cancer patients at diagnosis and one year later. J Pediatr Psychol. 1988 Jun;13(2):183–196. doi: 10.1093/jpepsy/13.2.183. [DOI] [PubMed] [Google Scholar]
  5. Cousens P., Waters B., Said J., Stevens M. Cognitive effects of cranial irradiation in leukaemia: a survey and meta-analysis. J Child Psychol Psychiatry. 1988 Nov;29(6):839–852. doi: 10.1111/j.1469-7610.1988.tb00757.x. [DOI] [PubMed] [Google Scholar]
  6. Dowell R. E., Jr, Copeland D. R., Francis D. J., Fletcher J. M., Stovall M. Absence of synergistic effects of CNS treatments on neuropsychologic test performance among children. J Clin Oncol. 1991 Jun;9(6):1029–1036. doi: 10.1200/JCO.1991.9.6.1029. [DOI] [PubMed] [Google Scholar]
  7. Fletcher J. M., Copeland D. R. Neurobehavioral effects of central nervous system prophylactic treatment of cancer in children. J Clin Exp Neuropsychol. 1988 Aug;10(4):495–537. doi: 10.1080/01688638808408255. [DOI] [PubMed] [Google Scholar]
  8. Gangji D., Reaman G. H., Cohen S. R., Bleyer W. A., Poplack D. G. Leukoencephalopathy and elevated levels of myelin basic protein in the cerebrospinal fluid of patients with acute lymphoblastic leukemia. N Engl J Med. 1980 Jul 3;303(1):19–21. doi: 10.1056/NEJM198007033030106. [DOI] [PubMed] [Google Scholar]
  9. Hanefeld F., Riehm H. Therapy of acute lymphoblastic leukaemia in childhood: effects on the nervous system. Neuropadiatrie. 1980 Feb;11(1):3–16. doi: 10.1055/s-2008-1071370. [DOI] [PubMed] [Google Scholar]
  10. Leiper A. D., Chessells J. Acute lymphoblastic leukaemia under 2 years. Arch Dis Child. 1986 Oct;61(10):1007–1012. doi: 10.1136/adc.61.10.1007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Longeway K., Mulhern R., Crisco J., Kun L., Lauer S., Casper J., Camitta B., Hoffman R. G. Treatment of meningeal relapse in childhood acute lymphoblastic leukemia: II. A prospective study of intellectual loss specific to CNS relapse and therapy. Am J Pediatr Hematol Oncol. 1990 Spring;12(1):45–50. doi: 10.1097/00043426-199021000-00008. [DOI] [PubMed] [Google Scholar]
  12. McIntosh S., Fischer D. B., Rothman S. G., Rosenfield N., Lobel J. S., O'Brien R. Intracranial calcifications in childhood leukemia. An association with systemic chemotherapy. J Pediatr. 1977 Dec;91(6):909–913. doi: 10.1016/s0022-3476(77)80888-3. [DOI] [PubMed] [Google Scholar]
  13. McIntosh S., Klatskin E. H., O'Brien R. T., Aspnes G. T., Kammerer B. L., Snead C., Kalavsky S. M., Pearson H. A. Chronic neurologic disturbance in childhood leukemia. Cancer. 1976 Feb;37(2):853–857. doi: 10.1002/1097-0142(197602)37:2<853::aid-cncr2820370234>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  14. Ochs J., Mulhern R. K. Late effects of antileukemic treatment. Pediatr Clin North Am. 1988 Aug;35(4):815–833. doi: 10.1016/s0031-3955(16)36511-7. [DOI] [PubMed] [Google Scholar]
  15. Peylan-Ramu N., Poplack D. G., Pizzo P. A., Adornato B. T., Di Chiro G. Abnormal CT scans of the brain in asymptomatic children with acute lymphocytic leukemia after prophylactic treatment of the central nervous system with radiation and intrathecal chemotherapy. N Engl J Med. 1978 Apr 13;298(15):815–818. doi: 10.1056/NEJM197804132981504. [DOI] [PubMed] [Google Scholar]
  16. Pinkerton C. R., Chessells J. M. Failed central nervous system prophylaxis in children with acute lymphoblastic leukaemia: treatment and outcome. Br J Haematol. 1984 Aug;57(4):553–561. [PubMed] [Google Scholar]
  17. Price R. A., Jamieson P. A. The central nervous system in childhood leukemia. II. Subacute leukoencephalopathy. Cancer. 1975 Feb;35(2):306–318. doi: 10.1002/1097-0142(197502)35:2<306::aid-cncr2820350203>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  18. Wheeler K., Leiper A. D., Jannoun L., Chessells J. M. Medical cost of curing childhood acute lymphoblastic leukaemia. Br Med J (Clin Res Ed) 1988 Jan 16;296(6616):162–166. doi: 10.1136/bmj.296.6616.162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Wilson D. A., Nitschke R., Bowman M. E., Chaffin M. J., Sexauer C. L., Prince J. R. Transient white matter changes on MR images in children undergoing chemotherapy for acute lymphocytic leukemia: correlation with neuropsychologic deficiencies. Radiology. 1991 Jul;180(1):205–209. doi: 10.1148/radiology.180.1.2052695. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES