Neuropsychological outcomes in children with acute lymphoblastic leukemia

Abstract

Acute Lymphoblastic Leukemia (ALL) and related blood cancers are the most common malignancy diagnosed in children. Mortality rates have declined significantly in the past several decades with advances in treatment approaches, including chemotherapeutic agents and cranial radiation, and approximately 80–85 % of children with leukemia are now surviving beyond 5 years post-diagnosis. Due to the increased survival rate, children are now facing many late effects following treatment, including cognitive dysfunction. There are many factors that are associated with increased risk for cognitive late effects. This chapter will provide a comprehensive review of the literature, addressing the various treatment protocols that are associated with increased risk for these cognitive late effects, and will examine the role of cranial radiation, chemotherapy, and glucocorticoids on the developing brain. Specific functions, such as intelligence, academic functioning, attention, sensorimotor, visual-motor, visual-spatial, executive function, and memory, have all been shown to be differentially impacted and are dependent upon several different variables currently known, including types and method of delivery of chemotherapeutic agents, dosage of cranial radiation, and uses of glucocorticoids. Furthermore, we will discuss individual variables, such as gender, age, and premorbid level of functioning, that research has identified as influencing cognitive morbidity. A case presentation will provide the reader with an example of how these variables might manifest, and how neuropsychological evaluation and neuroimaging can provide valuable data to help guide treatment planning for long-term follow-up of the childhood cancer survivor.