University of Minnesota, Minneapolis, MN, USA.
Children's Minnesota Cancer and Blood Disorders Program, Minneapolis, MN, USA.
J Pediatr Oncol Nurs. 2020 Jul/Aug;37(4):244-254. doi: 10.1177/1043454220909785. Epub 2020 Mar 6.
During treatment for acute lymphoblastic leukemia (ALL), children report co-occurring symptoms of fatigue, sleep disturbance, pain, nausea, and depression as a symptom cluster. Central nervous system-directed ALL therapies also put children at risk for cognitive impairments. Cancer therapies can cause an increase in oxidative stress, which may contribute to treatment-related symptoms. This study examined the longitudinal relationships between biomarkers of oxidative stress in the cerebrospinal fluid, the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L), and cognition, in children over the first year of ALL treatment. Glutathione (GSH) biomarkers of oxidative stress were measured in cerebrospinal fluid collected during treatment lumbar punctures. GSH biomarkers, symptoms, and cognitive function of 132 children aged 3 to 18 years were evaluated at four time points during the first year of leukemia treatment. Participants, 7 years and older, completed self-report measures, and parents reported for younger children. Cognitive function measurements for all participants were completed by parents. A longitudinal parallel-process model was used to explore the influence of the initial measurement and the subsequent change over four time points of the GSH biomarkers on the CCSC-L and cognition. GSH biomarkers increased over the four time points indicating decreasing oxidative stress. When GSH biomarkers were higher (less oxidative stress) at the initial measurement, the CCSC-L severity was lower, cognition was better, and cognition improved over the four measurements. Screening children for high levels of oxidative stress would be a foundation for future intervention studies to address symptom distress and cognitive impairments.
在治疗急性淋巴细胞白血病（ALL）期间，儿童报告同时出现疲劳、睡眠障碍、疼痛、恶心和抑郁等症状，这些症状构成了一个症状群。中枢神经系统定向的 ALL 治疗也使儿童面临认知障碍的风险。癌症治疗会导致氧化应激增加，这可能导致与治疗相关的症状。本研究在 ALL 治疗的第一年，通过纵向研究观察了脑脊液中氧化应激生物标志物与儿童癌症症状群-白血病（CCSC-L）以及认知之间的关系。在治疗腰椎穿刺期间采集脑脊液，以测量氧化应激的谷胱甘肽（GSH）生物标志物。在白血病治疗的第一年的四个时间点，评估了 132 名 3 至 18 岁儿童的 GSH 生物标志物、症状和认知功能。年龄在 7 岁及以上的参与者完成了自我报告的测量，而年龄较小的儿童则由父母报告。所有参与者的认知功能测量均由父母完成。使用纵向平行过程模型来探索 GSH 生物标志物在四个时间点的初始测量值及其随后的变化对 CCSC-L 和认知的影响。GSH 生物标志物在四个时间点上增加，表明氧化应激减少。当初始测量时 GSH 生物标志物较高（氧化应激较小）时，CCSC-L 严重程度较低，认知功能较好，且在四个测量中认知功能均有所改善。对高氧化应激水平的儿童进行筛查，将为未来干预研究提供基础，以解决症状困扰和认知障碍问题。
