Ellen van der Plas1, Weiyu Qiu2, Brian J Nieman3, Yutaka Yasui4, Qi Liu2, Stephanie B Dixon5, Nina S Kadan-Lottick6, Christopher B Weldon7, Brent R Weil7, Lisa M Jacola8, Todd M Gibson9, Wendy Leisenring10, Kevin Oeffinger11, Melissa M Hudson5, Leslie L Robison4, Gregory T Armstrong4, Kevin R Krull8. 1. University of Iowa Hospital & Clinics, Department of Psychiatry, Iowa City, IA, USA. 2. University of Alberta, School of Public Health, Edmonton, Alberta, Canada. 3. The Hospital for Sick Children, Translational Medicine, Toronto, Ontario, Canada. 4. St Jude Children's Research Hospital, Epidemiology and Cancer Control Department, Memphis, TN, USA. 5. St Jude Children's Research Hospital, Oncology Department, Memphis, TN, USA. 6. Yale University School of Medicine, Pediatric Hematology & Oncology, New Haven, CT, USA. 7. Boston Children's Hospital, Department of Surgery, Boston, MA, USA. 8. St Jude Children's Research Hospital, Psychology Department, Memphis, TN, USA. 9. National Institutes of Health, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA. 10. Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA. 11. Duke University, Medical Oncology, Durham, NC, USA.
Abstract
BACKGROUND: The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only. METHODS: This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided. RESULTS: Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.31 to 2.74; females: 12.5% vs 17.6%; OR = 1.50, 95% CI = 1.07 to 2.14), as well as impaired memory (males: 11.6% vs 19.9%, OR = 1.89, CI = 1.31 to 2.74; females: 14.78% vs 25.4%, OR = 1.96, 95% CI = 1.43 to 2.70, respectively). Among male survivors, impaired task efficiency was associated with 2-4 neurologic conditions (OR = 4.33, 95% CI = 1.76 to 10.68) and with pulmonary conditions (OR = 4.99, 95% CI = 1.51 to 16.50), and impaired memory was associated with increased cumulative dose of intrathecal methotrexate (OR = 1.68, 95% CI = 1.16 to 2.46) and with exposure to dexamethasone (OR = 2.44, 95% CI = 1.19 to 5.01). In female survivors, grade 2-4 endocrine conditions were associated with higher risk of impaired task efficiency (OR = 2.19, 95% CI = 1.20 to 3.97) and memory (OR = 2.26, 95% CI = 1.31 to 3.92). CONCLUSION: Neurocognitive impairment is associated with methotrexate, dexamethasone, and chronic health conditions in a sex-specific manner, highlighting the need to investigate physiological mechanisms and monitor impact through survivorship.
BACKGROUND: The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only. METHODS: This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided. RESULTS: Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.31 to 2.74; females: 12.5% vs 17.6%; OR = 1.50, 95% CI = 1.07 to 2.14), as well as impaired memory (males: 11.6% vs 19.9%, OR = 1.89, CI = 1.31 to 2.74; females: 14.78% vs 25.4%, OR = 1.96, 95% CI = 1.43 to 2.70, respectively). Among male survivors, impaired task efficiency was associated with 2-4 neurologic conditions (OR = 4.33, 95% CI = 1.76 to 10.68) and with pulmonary conditions (OR = 4.99, 95% CI = 1.51 to 16.50), and impaired memory was associated with increased cumulative dose of intrathecal methotrexate (OR = 1.68, 95% CI = 1.16 to 2.46) and with exposure to dexamethasone (OR = 2.44, 95% CI = 1.19 to 5.01). In female survivors, grade 2-4 endocrine conditions were associated with higher risk of impaired task efficiency (OR = 2.19, 95% CI = 1.20 to 3.97) and memory (OR = 2.26, 95% CI = 1.31 to 3.92). CONCLUSION: Neurocognitive impairment is associated with methotrexate, dexamethasone, and chronic health conditions in a sex-specific manner, highlighting the need to investigate physiological mechanisms and monitor impact through survivorship.
Authors: Daniel J Zheng; Kevin R Krull; Yan Chen; Lisa Diller; Yutaka Yasui; Wendy Leisenring; Pim Brouwers; Rebecca Howell; Jin-Shei Lai; Lyn Balsamo; Kevin C Oeffinger; Leslie L Robison; Gregory T Armstrong; Nina S Kadan-Lottick Journal: Cancer Date: 2018-06-11 Impact factor: 6.860
Authors: Wassim Chemaitilly; Laurie E Cohen; Sogol Mostoufi-Moab; Briana C Patterson; Jill H Simmons; Lillian R Meacham; Hanneke M van Santen; Charles A Sklar Journal: J Clin Oncol Date: 2018-06-06 Impact factor: 44.544
Authors: Leslie L Robison; Gregory T Armstrong; John D Boice; Eric J Chow; Stella M Davies; Sarah S Donaldson; Daniel M Green; Sue Hammond; Anna T Meadows; Ann C Mertens; John J Mulvihill; Paul C Nathan; Joseph P Neglia; Roger J Packer; Preetha Rajaraman; Charles A Sklar; Marilyn Stovall; Louise C Strong; Yutaka Yasui; Lonnie K Zeltzer Journal: J Clin Oncol Date: 2009-04-13 Impact factor: 44.544
Authors: Kevin C Oeffinger; Ann C Mertens; Charles A Sklar; Toana Kawashima; Melissa M Hudson; Anna T Meadows; Debra L Friedman; Neyssa Marina; Wendy Hobbie; Nina S Kadan-Lottick; Cindy L Schwartz; Wendy Leisenring; Leslie L Robison Journal: N Engl J Med Date: 2006-10-12 Impact factor: 176.079
Authors: Kellen Gandy; Matthew A Scoggins; Nicholas Phillips; Ellen van der Plas; Slim Fellah; Lisa M Jacola; Ching-Hon Pui; Melissa M Hudson; Wilburn E Reddick; Ranganatha Sitaram; Kevin R Krull Journal: JNCI Cancer Spectr Date: 2022-03-02
Authors: Satomi Sato; Nan Li; Stephanie B Dixon; Miho Kato; Hui Zhang; Chi Kong Li; Rebecca M Howell; Wendy M Leisenring; Smita Bhatia; Kevin C Oeffinger; Gregory T Armstrong; Yutaka Yasui; Kevin R Krull; Yin Ting Cheung Journal: Cancer Epidemiol Biomarkers Prev Date: 2021-10-04 Impact factor: 4.254
Authors: Liwen Peng; Lok Sum Yang; Perri Yam; Chun Sing Lam; Agnes Sui-Yin Chan; Chi Kong Li; Yin Ting Cheung Journal: Front Oncol Date: 2021-04-20 Impact factor: 6.244
Authors: Hend M Al-Kaylani; Erin E Reasoner; Bradley T Loeffler; Sarah L Mott; Susan Madasu; Audrey Liu; Kathleen Langbehn; Amy L Conrad; David Dickens; Amanda Grafft; Lyndsay Harshman; Arunkumar J Modi; Ellen van der Plas Journal: Cancer Rep (Hoboken) Date: 2021-09-30