PURPOSE: Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs and neurologic complications in long-term survivors are inadequately studied. This study investigated neurologic morbidity and its effect on quality of life in long-term survivors of childhood ALL. METHODS: Prospective, single institution, cross-sectional, institutional review board-approved study of long-term ALL survivors. Participants were recruited from institutional clinics. Participants answered an investigator-administered questionnaire followed by evaluation by a neurologist. Quality of life (QOL) was also assessed. RESULTS: Of the 162 participants recruited over a 3-year period, 83.3% reported at least one neurologic symptom of interest, 16.7% had single symptom, 11.1% had two symptoms, and 55.6% had three or more symptoms. Symptoms were mild and disability was low in the majority of participants with neurologic symptoms. Median age at ALL diagnosis was 3.9 years (0.4-18.6), median age at study enrollment was 15.7 years (6.9-28.9), and median time from completion of ALL therapy was 7.4 years (1.9-20.3). On multivariable analyses, female sex correlated with presence of dizziness, urinary incontinence, constipation, and neuropathy; use of ≥10 doses of triple intrathecal chemotherapy correlated with urinary incontinence, back pain, and neuropathy; cranial radiation with ataxia; history of ALL relapse with fatigue; and CNS leukemia at diagnosis with seizures. Decline in mental QOL was associated with migraine and tension type headaches, while physical QOL was impaired by presence of dizziness and falls. Overall, good QOL and physical function was maintained by a majority of participants. CONCLUSIONS: Neurologic symptoms were present in 83% long-term ALL survivors. Symptoms related morbidity and QOL impairment is low in majority of survivors. Female sex, ≥10 doses of intrathecal chemotherapy, and history of ALL relapse predispose to impaired QOL. IMPLICATIONS FOR CANCER SURVIVORS: This study will educate survivors and their care providers regarding cancer or treatment-related neurologic symptoms and morbidity. This study will help them understand factors contributing to impaired QOL when present.
PURPOSE: Childhood acute lymphoblastic leukemia (ALL) is treated with potentially neurotoxic drugs and neurologic complications in long-term survivors are inadequately studied. This study investigated neurologic morbidity and its effect on quality of life in long-term survivors of childhood ALL. METHODS: Prospective, single institution, cross-sectional, institutional review board-approved study of long-term ALL survivors. Participants were recruited from institutional clinics. Participants answered an investigator-administered questionnaire followed by evaluation by a neurologist. Quality of life (QOL) was also assessed. RESULTS: Of the 162 participants recruited over a 3-year period, 83.3% reported at least one neurologic symptom of interest, 16.7% had single symptom, 11.1% had two symptoms, and 55.6% had three or more symptoms. Symptoms were mild and disability was low in the majority of participants with neurologic symptoms. Median age at ALL diagnosis was 3.9 years (0.4-18.6), median age at study enrollment was 15.7 years (6.9-28.9), and median time from completion of ALL therapy was 7.4 years (1.9-20.3). On multivariable analyses, female sex correlated with presence of dizziness, urinary incontinence, constipation, and neuropathy; use of ≥10 doses of triple intrathecal chemotherapy correlated with urinary incontinence, back pain, and neuropathy; cranial radiation with ataxia; history of ALL relapse with fatigue; and CNS leukemia at diagnosis with seizures. Decline in mental QOL was associated with migraine and tension type headaches, while physical QOL was impaired by presence of dizziness and falls. Overall, good QOL and physical function was maintained by a majority of participants. CONCLUSIONS: Neurologic symptoms were present in 83% long-term ALL survivors. Symptoms related morbidity and QOL impairment is low in majority of survivors. Female sex, ≥10 doses of intrathecal chemotherapy, and history of ALL relapse predispose to impaired QOL. IMPLICATIONS FOR CANCER SURVIVORS: This study will educate survivors and their care providers regarding cancer or treatment-related neurologic symptoms and morbidity. This study will help them understand factors contributing to impaired QOL when present.
Authors: P J Dyck; W R Sherman; L M Hallcher; F J Service; P C O'Brien; L A Grina; P J Palumbo; C J Swanson Journal: Ann Neurol Date: 1980-12 Impact factor: 10.422
Authors: Lang Li; Tammy Sajdyk; Ellen M L Smith; Chien Wei Chang; Claire Li; Richard H Ho; Raymond Hutchinson; Elizabeth Wells; Jodi L Skiles; Naomi Winick; Paul L Martin; Jamie L Renbarger Journal: Clin Pharmacol Ther Date: 2019-01-21 Impact factor: 6.875
Authors: Ellen M Lavoie Smith; Lang Li; ChienWei Chiang; Karin Thomas; Raymond J Hutchinson; Elizabeth M Wells; Richard H Ho; Jodi Skiles; Arindom Chakraborty; Celia M Bridges; Jamie Renbarger Journal: J Peripher Nerv Syst Date: 2015-03 Impact factor: 3.494
Authors: J Vetsch; C E Wakefield; E G Robertson; T N Trahair; M K Mateos; M Grootenhuis; G M Marshall; R J Cohn; J E Fardell Journal: Qual Life Res Date: 2018-01-25 Impact factor: 4.147
Authors: J E Wells; M Howlett; H M Halse; J Heng; J Ford; L C Cheung; A L Samuels; M Crook; A K Charles; C H Cole; U R Kees Journal: Oncogene Date: 2016-01-25 Impact factor: 9.867
Authors: Kirsten K Ness; Melissa M Hudson; Kendra E Jones; Wendy Leisenring; Yutaka Yasui; Yan Chen; Marilyn Stovall; Todd M Gibson; Daniel M Green; Joseph P Neglia; Tara O Henderson; Jacqueline Casillas; Jennifer S Ford; Karen E Effinger; Kevin R Krull; Gregory T Armstrong; Leslie L Robison; Kevin C Oeffinger; Paul C Nathan Journal: Ann Intern Med Date: 2016-11-08 Impact factor: 25.391
Authors: Fiona S M Schulte; Michaela Patton; Nicole M Alberts; Alicia Kunin-Batson; Barbara A Olson-Bullis; Caitlin Forbes; K Brooke Russell; Alexandra Neville; Lauren C Heathcote; Cynthia W Karlson; Nicole M Racine; Courtney Charnock; Matthew C Hocking; Pia Banerjee; Perri R Tutelman; Melanie Noel; Kevin R Krull Journal: Cancer Date: 2020-10-28 Impact factor: 6.860
Authors: Luke P Legakis; Clare M Diester; Edward A Townsend; Ladan Karim-Nejad; Sidney Stevens Negus Journal: Behav Pharmacol Date: 2020-08 Impact factor: 2.277