Advanced Biomedical Research

Comparison of intelligence quotient in children surviving leukemia who received different prophylactic central nervous system treatments

Authors

1 Pediatric Hematologist and Oncologist, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

2 Resident of Pediatrics, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Neurocognitive deficits and decrease in intelligence quotient (IQ) is one of the complication of prophylactic central nervous system (CNS) treatment in acute lymphoblastic leukemia (ALL) patients. In this study, we compare the IQ in survivors of ALL that were treated with different prophylactic CNS treatments.
Materials and Methods : We compared 43 long-term survivors of ALL: 21 survivors with intrathecal methotrexate (IT MTX) as CNS prophylaxis, 22 with IT MTX+1800-2400 rads cranial irradiation and 20 healthy controls. The IQ was measured using the Raven's test in these patients.
Results: Raven's test revealed significant differences in IQ between the survivors of ALL that were treated with IT MTX, IT MTX plus cranial irradiation and control group. There was no significant difference in the IQ with respect to sex, age and irradiation dose.
Conclusion: We can that reveal that CNS prophylaxis treatment, especially the combined treatment, is associated with IQ score decline in ALL survivors. Therefore,a baseline and an annual assessment of their educational progress are suggested.

1. Carey ME, Haut MW, Reminger SL, Hutter JJ, Theilmann R, Kaemingk KL, et al. Reducedfrontal white matter volume in long-term childhood leukemiasurvivors: Avoxel-based morphometrystudy.AJNR Am J Neuroradiol2008;29:792-97.  Back to cited text no. 1
    
2. WilliamsJ, Michael, Davis Kelli S. Central nervous system prophylactic treatment for childhood leukemia: neuropsychological outcome studies. Cancer Treat Rev 1986;13:113-27.  Back to cited text no. 2
    
3. Allen JC. The effects of cancer therapy on the nervous system. JPediatr1978;93:903-9.  Back to cited text no. 3
[PUBMED]    
4. Montour-Proulx I, Kuehn SM, Keene DL,Barrowman NJ, Hsu E, Matzinger MA, et al. Cognitive changes in children treated for acute lymphoblastic leukemia with chemotherapy only according to the Pediatric Oncology Group 9605 Protocol. J Child Neurol 2005;20:129-33.  Back to cited text no. 4
    
5. Saro H, Armenian, Anna T.Medows and Smita Bhatia. Late effects of childhood cancer and its treatment. (Neurocongnitive Sequelae) in Pizzo, Philip A,Poplack David G. Principles and Practice of Pediatric Oncology,6th edition. 2011. p. 137-4.  Back to cited text no. 5
    
6. Mulhern RK, Reddick WE, Palmer SL, Glass JO, Elkin TD, Kun LE, et al. Neurocognitive deficits in medulloblastoma survivors and white matter loss. Ann Neurol 1999;46:834-41.  Back to cited text no. 6
    
7. Reddick WE, WhiteHA, Class JO, Wheeler GC, Thompson SJ, Gajjar A, et al. Developmental model relating whitematter volume to neurocognitive deficits in pediatric brain tumor survivors. Cancer 2003;97:2512-9.  Back to cited text no. 7
    
8. Reddick WE, Shan ZY, Glass JO, Helton S, Xiong X, Wu S,et al. Smaller white-matter volumes are associated with larger deficits in attention and learning among long-term survivors of acute lymphoblastic leukemia. Cancer 2006;106:941-9.  Back to cited text no. 8
    
9. Brown RT,Sawyer MB, Antoniou G, Toogood I, Rice M, Thompson N, et al. A 3-year follow-up of the intellectual and academic functioning of children receiving central nervous system prophylactic chemotherapy for leukemia. J DevBehavPediatr 1996;17:392-8.  Back to cited text no. 9
    
10. http://www.greatschools.org/california/los-angeles/community/discussion.gs?content=4119(What is the Raven Test for gifted child all about?)  Back to cited text no. 10
    
11. http://ww http://www.iqtest.dk/main.SWF.  Back to cited text no. 11
    
12. www.personality-and-aptitude-career-test./com/ravens-test.html.  Back to cited text no. 12
    
13. Halberg FE, Kramer JH, Moore IM,Wara WM, Matthay KK, Ablin AR. Prophylactic cranial irradiation dose effects on late congnitive function in children treated for acute lymphoblastic leukemia.Int J RadiatOncol Bio Phys 1992;22:13-6.  Back to cited text no. 13
[PUBMED]    
14. Cetingül N,Aydinok Y, Kantar M, Oniz H, Kavakli K, Yalman O, et al.Neuropsychologicsequelae in the long-term survivors of childhood acutelymphoblastic leukemia.PediatrHemtol Oncol1999;16:213-20.  Back to cited text no. 14
    
15. Ramond-Speden E, Tripp G, Lawrence B, Holdaway D . Intellectual, neuropsychological and academic functioning in long-term survivors of leukemia.JPediatrPsychol 2000;25:59-68.  Back to cited text no. 15
    
16. Duffner PK. Long-term effects of radiation therapy on cognitive and endocrine function in children with leukemia and brain tumors. Neurologist 2004;10:293-310.  Back to cited text no. 16
    
17. Soni SS, Marten GW,Pitner SE, Duenas DA, Powazek M. Effects of CNS irradiation on neuropsychologic functioning of children with acute lymphoblastic leukemia. NEngl J Med1975;293:113-8.  Back to cited text no. 17
    
18. Mulhern PK,Fairclough D, Ochus J. A prospective comparison of neuropyschologic performance of children surviving leukemia who received 18-Gy, 24-Gy, or no cranial irradiation. J ClinOncol1991;9:1348-56  Back to cited text no. 18
    
19. Liu HC, Liang DC, Chen SH, Lo CY, Tseng KP, Kuo TB, et al. Intelligence quotient in childhood acute lymphoblastic leukemia afterprophylactic treatment in central nervous system with 18 Gy cranial irradiation and intrathecal methotrexate.Zhonghua Min Guo Xiao ErKe Yi XueHuiZaZhi1996;37:107-10[Abstract/PMID:8935408].  Back to cited text no. 19
    
20. Kolotas C, Daniel M,Demetriou L,Martin T, Kurek R, Tonus C, et al. Long-term effects on the intelligence of children treated for acute lymphoblastic leukemia. Cancer Invest 2001;19:581-7.  Back to cited text no. 20
    
21. Krappmann P, Paulides M, Stöhr W, Ittner E, Plattig B, Nickel P, et al. Almost normal cognitive function in patients during therapy for childhood acute lymphoblastic leukemia without cranial irradiation according to ALL-BFM 95 and COALL 06-97 protocols: Results of an Austrian-German multicenter longitudinal study and implication for follow-up. Pediatric HematolOncol 2007;24:101-9.  Back to cited text no. 21
    
22. Brown RT, Madam-Swain A, WalcoGA, Cherrick I, Ievers CE, Conte PM,et al.Congnitive and academic late effects among children previously treated for acute lymphocytic leukemia receiving chemotherapy as CNS prophylaxis. J PediatrPsychol 1998;23:333-40.  Back to cited text no. 22
    
23. Fossen A, Abrahamsen TG, Storm-Mathisen I. Psychological outcome in children treated for brain tumor.PediatrHematolOncol 1998;15:479-88.  Back to cited text no. 23
    
24. Lesnik PG,Ciesieiski KT, Hart BL, Benzel EC, Sanders JA.Evidence for cerebellar-frontal subsystemchanges in children treated with intrathecal chemotherapy for leukemia: enhanced data analysis using an effect size model. Arch Neurol1998;55:1561-8.  Back to cited text no. 24
    
Advanced Biomedical Research
Volume 2012, October
October 2012
Pages 1-5