Children's National Hospital, Washington, District of Columbia, USA.
The George Washington University School of Medicine, Washington, District of Columbia, USA.
Pediatr Blood Cancer. 2023 Jul;70(7):e30350. doi: 10.1002/pbc.30350. Epub 2023 May 2.
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer diagnosis. Cognitive late effects develop in 20%-40% of ALL survivors, but the course of declines is unclear. The aim of this paper is to characterize cognitive functioning, and its association with patient-reported outcomes, early in treatment.
A total of 483 children with high-risk ALL, aged 6-12 years at diagnosis, consented to the neurocognitive study embedded in a prospective therapeutic trial, Children's Oncology Group (COG) AALL1131. A computerized neurocognitive battery (Cogstate) was administered 3 months post diagnosis assessing reaction time, visual attention, working memory, visual learning, and executive functioning. Parent-reported executive functioning and patient-reported physical symptoms were also collected.
Data from 390 participants (mean age at diagnosis = 9.2 years, 55.4% male) were obtained. Relatively few patients reported pain (16.0%) or nausea (22.6%), but a majority (68.5%) reported feeling at least some fatigue at testing. Mean Cogstate Z-scores were within normal limits across tasks; however, rates of impairment (Z-scores ≤ -1.5) for reaction time, working memory, visual learning, and visual attention were all higher than expected compared to the standardization sample. Patients reporting fatigue were significantly more likely to have impaired reaction time and visual attention compared to those reporting no fatigue.
Findings support feasibility of computerized cognitive assessments and suggest higher-than-expected rates of impaired cognitive performance early during treatment for pediatric ALL, notably within 3 months of diagnosis, suggesting intervention efforts may be indicated. These results also highlight acute factors that may impact reliability of "baseline" assessments conducted soon after diagnosis.
急性淋巴细胞白血病（ALL）是最常见的儿科癌症诊断。20%-40%的 ALL 幸存者会出现认知后期效应，但下降的过程尚不清楚。本文旨在描述治疗早期的认知功能及其与患者报告结局的关系。
共有 483 名高危 ALL 患儿入组，诊断时年龄为 6-12 岁，同意参加前瞻性治疗试验（儿童肿瘤学组 COG AALL1131）中的神经认知研究。在诊断后 3 个月，使用计算机化神经认知测试（Cogstate）评估反应时间、视觉注意力、工作记忆、视觉学习和执行功能。还收集了父母报告的执行功能和患者报告的身体症状。
390 名参与者（诊断时平均年龄为 9.2 岁，55.4%为男性）的数据可用。相对较少的患者报告疼痛（16.0%）或恶心（22.6%），但大多数（68.5%）患者在测试时至少感到一些疲劳。在所有任务中，Cogstate 的平均 Z 分数均在正常范围内；然而，与标准化样本相比，反应时间、工作记忆、视觉学习和视觉注意力的损伤率（Z 分数≤-1.5）都更高。报告疲劳的患者与报告无疲劳的患者相比，反应时间和视觉注意力受损的可能性显著更高。
研究结果支持计算机化认知评估的可行性，并表明儿科 ALL 治疗早期（尤其是诊断后 3 个月内）存在高于预期的认知功能障碍发生率，这表明可能需要干预措施。这些结果还强调了可能影响诊断后不久进行的“基线”评估可靠性的急性因素。
