Ramjan Sameera, Blair Thies Melanie, Li Yuelin, Thrope Alexandra, Silverman Lewis, Welch Jennifer J G, Kahn Justine, Kelly Kara M, Tran Thai-Hoa, Michon Bruno, Gennarini Lisa, Bona Kira, Park Yongkyu, Cole Peter D, Sands Stephen A
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Pediatr Blood Cancer. 2025 Aug;72(8):e31767. doi: 10.1002/pbc.31767. Epub 2025 May 13.
This study describes neurocognitive functioning during the first month of induction chemotherapy for childhood acute lymphoblastic leukemia (ALL) and associations with age, sex, risk of relapse, maternal education, household material hardship (HMH), and oxidative stress.
Patients treated on protocol 16-001 (NCT03020030) across eight North American sites (2017-2022) consented for optional testing using Cogstate at six timepoints throughout treatment. The baseline data presented were collected within the first month after diagnosis.
Among 406 eligible patients, 330 (81%) consented (53% males, mean age = 8.8 years, SD = 4.7). Over 63% of participants performed within normal limits for their age range. Additionally, no relationship was observed at baseline between neurocognition and maternal education, HMH, or oxidative stress. In contrast, a linear relationship was observed between older age and weaker psychomotor speed (p < 0.0001), attention (p < 0.0001), and working memory (p = 0.019). Males also demonstrated faster psychomotor speed (p = 0.0027), while females demonstrated stronger visual learning (p = 0.011). Furthermore, having a higher risk of relapse was associated with slower psychomotor speed (p = 0.006) and weaker attention (p = 0.033).
Our findings indicate that most ALL patients in this study who were assessed at baseline did not display cognitive impairments, except for a small subset of participants who were below age expectations across domains. These baseline findings also identify subgroups based upon age, sex, and ALL risk classification that begin medical treatment with neurocognitive delays, warranting monitoring to elucidate whether exposure to therapy further impacts these domains. Additionally, the lack of impact on neurocognitive functioning at baseline of maternal education, HMH, and/or oxidative stress enables subsequent assessments to effectively identify the potential emergence of deficits as a result of exposure to medical treatment.
本研究描述了儿童急性淋巴细胞白血病（ALL）诱导化疗第一个月期间的神经认知功能，以及与年龄、性别、复发风险、母亲教育程度、家庭物质困难（HMH）和氧化应激的关联。
在北美八个地点（2017 - 2022年）接受方案16 - 001（NCT03020030）治疗的患者同意在整个治疗过程中的六个时间点使用Cogstate进行可选测试。呈现的基线数据是在诊断后的第一个月内收集的。
在406名符合条件的患者中，330名（81%）同意参与（53%为男性，平均年龄 = 8.8岁，标准差 = 4.7）。超过63%的参与者在其年龄范围内表现正常。此外，在基线时未观察到神经认知与母亲教育程度、HMH或氧化应激之间的关系。相比之下，年龄较大与心理运动速度较弱（p < 0.0001）、注意力（p < 0.0001）和工作记忆（p = 0.019）之间存在线性关系。男性的心理运动速度也更快（p = 0.0027），而女性的视觉学习能力更强（p = 0.011）。此外，复发风险较高与心理运动速度较慢（p = 0.006）和注意力较弱（p = 0.033）有关。
我们的研究结果表明，本研究中大多数在基线时接受评估的ALL患者没有表现出认知障碍，除了一小部分在各个领域低于年龄预期的参与者。这些基线研究结果还根据年龄、性别和ALL风险分类确定了开始接受治疗时存在神经认知延迟的亚组，需要进行监测以阐明接触治疗是否会进一步影响这些领域。此外，母亲教育程度、HMH和/或氧化应激在基线时对神经认知功能没有影响，这使得后续评估能够有效地识别由于接触治疗而可能出现的缺陷。
