Impact of Childhood Acute Lymphoblastic Leukemia and its Treatment on Social-Emotional, Intellectual, and Academic Abilities

Abstract

The occurrence of psychological late effects resulting from the diagnosis and treatment of pediatric acute lymphoblastic leukemia (ALL) been the subject of empirical investigations for approximately 25 years, with an emphasis on those patients treated with radiation therapy. In more recent years, however, research has shown that children and adolescents with ALL treated only with chemotherapy may also be at risk for treatment-related cognitive and academic deficits, although many specific treatment regimens remain to be investigated. Purpose: The present investigation was designed to examine 76 pediatric patients with ALL who were randomized to receive 1g/m² or 2g/m² of intravenous methotrexate (IVMTX) with regard to cognitive, academic, and social-emotional/behavioral functioning over a 3-year period beginning shortly after diagnosis. Method: Scores from a preexisting database were analyzed with particular interest in main effects for methotrexate dose level, time since diagnosis, age at diagnosis, ALL vs non-ALL status and interactions between group and time variables. Participants with ALL and group of non-ALL siblings had participated in cognitive evaluations measuring performance in the following domains: intelligence, language, visual-spatial/visual-motor skills, attention and working memory, processing speed, psychomotor speed and coordination, executive function, academic achievement, and social-emotional/behavioral functioning. Results: A main effect for methotrexate dose level was significant for a measure of adaptive skills. A main effect for age at diagnosis was noted on measures of visual-spatial attention and working memory, and spelling and written expression. No main effect for time was noted on any dependent measure. Additionally, no main effect for ALL versus non-ALL status was noted on any dependent measure. Conclusion: Overall the findings suggest that the treatment of ALL with 1g/m² or 2g/m² IVMTX does not significantly impact the incidence of late effects with regard to cognitive, academic, and social-emotional/behavioral functioning within the first 3 years post-diagnosis. Younger age at diagnosis may, however, contribute to differences in performance on measures of cognitive and academic functioning.