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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2019; 40(02): 222-231
DOI: 10.4103/ijmpo.ijmpo_138_18
Original Article

Neurocognitive and Neuroanatomical Changes in Children with Acute Lymphoblastic Leukemia Treated with the Modified BFM-95 Protocol

Authors

  • Sundaramoorthy Chidambaram

    Departments of Psycho-Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

  • Vidhubala Elangovan

    Departments of Psycho-Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

  • Vandana Mahajan

    Departments of Radiology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

  • Prasanth Ganesan

    Departments of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

  • Venkatraman Radhakrishnan

    Departments of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

Financial support and sponsorship This study was financially supported by The Indian Council of Medical Research (ICMR), New Delhi, India.
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Abstract

Background: The use of cranial radiotherapy for central nervous system (CNS) prophylaxis in children with acute lymphoblastic leukemia (ALL) is debated owing to its effect on neurocognitive functioning, as only <30% of the patients present with low risk in India and majority of the patients with high risk have to be treated with cranial radiation therapy (CRT) to prevent relapse. Given the increasing number of ALL survivors in India, the effect of CRT on neurocognitive functioning in children with ALL needs to be studied. Methods: Children (n = 44) with ALL who received CRT, intrathecal methotrexate (IT-MTX), and high-dose methotrexate (HD-MTX) for CNS prophylaxis as part of the modified Berlin-Frankfurt-Munster 95 protocol were included. Neurocognitive assessments and magnetic resonance image were performed to assess neurocognitive functioning and neuroanatomical structures, respectively. Five assessments were performed during the induction, end of re-induction I and II, commencement of maintenance, and end of maintenance phases of the modified BFM-95 protocol. Neurocognitive data of children with ALL were compared with those of healthy children (n = 60) at the baseline and after the final assessment. Results: A significant deterioration was observed in the performance intelligence, visuospatial ability, processing speed, and verbal retention domains after the completion of CNS prophylaxis. Three children had white matter changes on magnetic resonance imaging and showed reduced functioning in performance intelligence quotient, working memory, visual immediate and delayed memory, processing speed, verbal retention, visuospatial ability, processing speed, attention, planning and fine motor skills, and verbal comprehension. Children with ALL had poorer neuropsychological functioning when compared with healthy children. Conclusion: CNS prophylactic therapy as part of the BFM-95 protocol had an adverse effect on the neuropsychological functioning of children with ALL, and the effect was more pronounced when CRT was added to the treatment.

Keywords

Acute lymphoblastic leukemia - BFM-95 protocol - central nervous system prophylactic treatment - chemotherapy - childhood cancer - cranial irradiation - neuropsychological functioning


Publication History

Article published online:
03 June 2021

© 2019. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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