Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1990 May;65(5):530–534. doi: 10.1136/adc.65.5.530

Decline in head growth and cognitive impairment in survivors of acute lymphoblastic leukaemia.

R E Appleton 1, K Farrell 1, J Zaide 1, P Rogers 1
PMCID: PMC1792150  PMID: 2357094

Abstract

Twenty five children in remission, who were asymptomatic and who had last been treated at least two years before for acute lymphoblastic leukaemia, were examined neurologically and neuropsychologically. Their treatment included early cranial irradiation (24 Gy or 18 Gy), intrathecal methotrexate, and systemic chemotherapy. One half of the children demonstrated a decline in head circumference centile, which occurred in all patients treated with 24 Gy and in those patients treated with 18 Gy under the age of 3 years. In those children whose head growth was reduced, performance was significantly impaired in neuropsychological tests designed to assess concentration and short term memory. These children also developed clinically important learning difficulties in the classroom. Minor neurological dysfunction was present in almost half of the entire group. These data suggest that the treatment employed to prevent central nervous system leukaemia (primarily cranial irradiation) has a deleterious effect on head and brain growth and intellectual function.

Full text

PDF
530

Selected References

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

  1. 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]
  2. COSTA L. D., VAUGHAN H. G., Jr, LEVITA E., FARBER N. Purdue Pegboard as a predictor of the presence and laterality of cerebral lesions. J Consult Psychol. 1963 Apr;27:133–137. doi: 10.1037/h0040737. [DOI] [PubMed] [Google Scholar]
  3. Dobbing J., Hopewell J. W., Lynch A., Sands J. Vulnerability of developing brain. I. Some lasting effects of x-irradiation. Exp Neurol. 1970 Sep;28(3):442–449. doi: 10.1016/0014-4886(70)90181-0. [DOI] [PubMed] [Google Scholar]
  4. Goff J. R., Anderson H. R., Jr, Cooper P. F. Distractibility and memory deficits in long-term survivors of acute lymphoblastic leukemia. J Dev Behav Pediatr. 1980 Dec;1(4):158–163. [PubMed] [Google Scholar]
  5. Jannoun L. Are cognitive and educational development affected by age at which prophylactic therapy is given in acute lymphoblastic leukaemia? Arch Dis Child. 1983 Dec;58(12):953–958. doi: 10.1136/adc.58.12.953. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Meadows A. T., Gordon J., Massari D. J., Littman P., Fergusson J., Moss K. Declines in IQ scores and cognitive dysfunctions in children with acute lymphocytic leukaemia treated with cranial irradiation. Lancet. 1981 Nov 7;2(8254):1015–1018. doi: 10.1016/s0140-6736(81)91216-2. [DOI] [PubMed] [Google Scholar]
  7. Moss H. A., Nannis E. D., Poplack D. G. The effects of prophylactic treatment of the central nervous system on the intellectual functioning of children with acute lymphocytic leukemia. Am J Med. 1981 Jul;71(1):47–52. doi: 10.1016/0002-9343(81)90257-6. [DOI] [PubMed] [Google Scholar]
  8. Mulhern R. K., Wasserman A. L., Fairclough D., Ochs J. Memory function in disease-free survivors of childhood acute lymphocytic leukemia given CNS prophylaxis with or without 1,800 cGy cranial irradiation. J Clin Oncol. 1988 Feb;6(2):315–320. doi: 10.1200/JCO.1988.6.2.315. [DOI] [PubMed] [Google Scholar]
  9. Nellhaus G. Head circumference from birth to eighteen years. Practical composite international and interracial graphs. Pediatrics. 1968 Jan;41(1):106–114. [PubMed] [Google Scholar]
  10. Pfefferbaum-Levine B., Copeland D. R., Fletcher J. M., Ried H. L., Jaffe N., McKinnon W. R., Jr Neuropsychologic assessment of long-term survivors of childhood leukemia. Am J Pediatr Hematol Oncol. 1984 Summer;6(2):123–128. doi: 10.1097/00043426-198406020-00002. [DOI] [PubMed] [Google Scholar]
  11. Poplack D. G. Acute lymphoblastic leukemia in childhood. Pediatr Clin North Am. 1985 Jun;32(3):669–697. doi: 10.1016/s0031-3955(16)34831-3. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Rapin I., Tourk L. M., Costa L. D. Evaluation of the Purdue Pegboard as a screening test for brain damage. Dev Med Child Neurol. 1966 Feb;8(1):45–54. doi: 10.1111/j.1469-8749.1966.tb08272.x. [DOI] [PubMed] [Google Scholar]
  14. Riccardi R., Brouwers P., Di Chiro G., Poplack D. G. Abnormal computed tomography brain scans in children with acute lymphoblastic leukemia: serial long-term follow-up. J Clin Oncol. 1985 Jan;3(1):12–18. doi: 10.1200/JCO.1985.3.1.12. [DOI] [PubMed] [Google Scholar]
  15. Sanuki E., Kamata R., Satoh K., Kumagai Y., Hashiba M., Takashima H., Saitoh T., Inana I., Fujii H. Effects of prophylactic irradiation of acute lymphoblastic leukemia in the central nervous system of children. Radiat Med. 1984 Jan-Mar;2(1):76–83. [PubMed] [Google Scholar]
  16. Stuss D. T., Benson D. F. Neuropsychological studies of the frontal lobes. Psychol Bull. 1984 Jan;95(1):3–28. [PubMed] [Google Scholar]
  17. Twaddle V., Britton P. G., Kernahan J., Craft A. W. Intellect after malignancy. Arch Dis Child. 1986 Jul;61(7):700–702. doi: 10.1136/adc.61.7.700. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Williams J. M., Davis K. S. Central nervous system prophylactic treatment for childhood leukemia: neuropsychological outcome studies. Cancer Treat Rev. 1986 Jun;13(2):113–127. doi: 10.1016/0305-7372(86)90016-2. [DOI] [PubMed] [Google Scholar]

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

RESOURCES