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. 2015 Jun:53:108-20.
doi: 10.1016/j.neubiorev.2015.03.016. Epub 2015 Apr 7.

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

Yin Ting Cheung  1 , Kevin R Krull  2
Affiliations

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

Yin Ting Cheung et al. Neurosci Biobehav Rev. 2015 Jun.

Abstract

The intensified administration of chemotherapeutic drugs has gradually replaced cranial radiation therapy (CRT) for the treatment of childhood acute lymphoblastic leukemia (ALL). While CRT is often implicated in neurocognitive impairment in ALL survivors, there is a paucity of the literature that evaluates the persistence of neurocognitive deficits in long-term survivors of pediatric ALL who were treated with contemporary chemotherapy-only protocols. Results from this systematic review concurred to the probable cognitive-sparing effect of chemotherapy-based protocols over CRT in long-term survivors. However, coupled with multiple intrinsic and extrinsic factors, survivors who received chemotherapy treatment still suffered from apparent cognitive impairment, particularly in the attention and executive function domains. Notably, there is evidence to suggest that the late neurotoxic effect of methotrexate on survivors' neurocognitive performance may be dose-related. This review also recommends future pharmacokinetic, neuroimaging and genetic studies to illuminate the multifactorial nature of this subject matter and discusses the potential value of neurochemical, physiological, inflammatory and genetic markers for the prediction of susceptibility to neurocognitive impairment in long-term survivors of childhood ALL.

Keywords: Acute lymphoblastic leukemia; Cancer survivorship; Chemotherapy; Neurocognitive; Pediatric cancer.

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Conflict of interest statement

DISCLOSURE: All authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Results of literature search CRT: Cranial radiation therapy; SCT: Stem-cell transplant
Figure 2
Figure 2
Intrinsic and extrinsic factors that contribute to neurocognitive outcomes in childhood acute lymphoblastic leukemia survivors ApoE: apolipoprotein E; CBS: cystathionine-β-synthase; CDH13: cadherin 13; COMT: catechol-O-methyltransferase; CNS: central nervous system; CSF: cerebrospinal fluid; GCSF: granulocyte-colony stimulating factor; GST: glutathione S-transferase; KIBRA: kidney and brain expressed protein; MAOA: monoamine oxidase A; MTHFR: methylenetetrahydrofolate reductase; MTR: methionine synthase reductase; MTX: methotrexate; NOS: nitric oxide synthase; PTSD: Post-traumatic stress disorder; TPH2: tryptophan hydroxylase-2; 5-HTLPR: serotonin-transporter-linked polymorphic region
See this image and copyright information in PMC

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