The impact of therapy for childhood acute lymphoblastic leukaemia on intelligence quotients; results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XIReport as inadecuate




The impact of therapy for childhood acute lymphoblastic leukaemia on intelligence quotients; results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XI - Download this document for free, or read online. Document in PDF available to download.

Journal of Hematology and Oncology

, 4:42

First Online: 13 October 2011Received: 19 August 2011Accepted: 13 October 2011

Abstract

BackgroundThe 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 × 10-l randomised to intrathecal methotrexate n = 197 versus intrathecal and high-dose intravenous methotrexate HDM n = 202, and 3 high-risk children WCC ≥ 50 × 10-l, age ≥ 2 years randomised to HDM n = 79 versus cranial irradiation n = 77.

ResultsThere 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.

ConclusionChildren 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.

Trial registrationISRCTN: ISRCTN16757172

Keywordsacute lymphoblastic leukaemia IQ central nervous system morbidity cranial radiotherapy methotrexate neuropsychometric paediatric List of AbbreviationsALLAcute lymphoblastic leukaemia

CNSCentral nervous system

IQIntelligence Quotient

MTXmethotrexate

WCCwhite cell count

ITintrathecal

HDMHigh dose methotrexate

XRTRadiotherapy

EFSEvent free survival

VIQVerbal intelligence quotient

PIQPerformance intelligence quotient

FSIQFull scale intelligence quotient

MRCMedical Research Council UK.

Electronic supplementary materialThe online version of this article doi:10.1186-1756-8722-4-42 contains supplementary material, which is available to authorized users.

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Author: Christina Halsey - Georgina Buck - Sue Richards - Faraneh Vargha-Khadem - Frank Hill - Brenda Gibson

Source: https://link.springer.com/



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