Journal
JOURNAL OF HEMATOLOGY & ONCOLOGY
Volume 4, Issue -, Pages -Publisher
BMC
DOI: 10.1186/1756-8722-4-42
Keywords
acute lymphoblastic leukaemia; IQ; central nervous system; morbidity; cranial radiotherapy; methotrexate; neuropsychometric; paediatric
Categories
Funding
- Medical Research Council (UK) [G9101597]
- Chief Scientist Office [SCD/08] Funding Source: researchfish
- Medical Research Council [MC_U137686856] Funding Source: researchfish
- MRC [G0300117, MC_U137686856] Funding Source: UKRI
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Background: The MRC UKALLXI trial tested the efficacy of different central nervous system (CNS) directed therapies in childhood acute lymphoblastic leukaemia (ALL). To evaluate morbidity 555/1826 randomised children underwent prospective psychological evaluations. Full Scale, verbal and performance IQs were measured at 5 months, 3 years and 5 years. Scores were compared in; (1) all patients (n = 555) versus related controls (n = 311), (2) low-risk children (presenting white cell count (WCC) < 50 x 10(9)/l) randomised to intrathecal methotrexate (n = 197) versus intrathecal and high-dose intravenous methotrexate (HDM) (n = 202), and (3) high-risk children (WCC >= 50 x 10(9)/l, age >= 2 years) randomised to HDM (n = 79) versus cranial irradiation (n = 77). Results: There were no significant differences in IQ scores between the treatment arms in either low-or high-risk groups. Despite similar scores at baseline, results at 3 and 5 years showed a significant reduction of between 3.6 and 7.3 points in all three IQ scores in all patient groups compared to controls (P < 0.002) with a higher proportion of children with IQs < 80 in the patient groups (13% vs. 5% at 3 years p = 0.003). Conclusion: Children with ALL are at risk of CNS morbidity, regardless of the mode of CNS-directed therapy. Further work needs to identify individuals at high-risk of adverse CNS outcomes.
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