Risk of Neurocognitive Issues in Survivors of ALL May Begin Before Treatment

Although the risk of neurocognitive issues is common in survivors of childhood lymphoblastic leukemia (ALL), a new study published in JAMA Oncology suggests that the risk may actually begin before treatment. 

Researchers analyzed the cerebrospinal fluid (CSF) of 235 children with ALL who were treated at St. Jude Children’s Research Hospital with chemotherapy alone. They examined concentration CSF biomarkers at diagnosis and during therapy to evaluate associations with long-term neurocognitive and neuroimaging outcomes. The group included 138 long-term survivors.

They found that, even before treatment began, the participants had large variations in concentrations of CSF markers, which suggested injury to glial cells, which make up white matter in the brain that help the brain function efficiently.

“This was a surprise. Until now, we had not suspected that leukemia, by itself, or the inflammatory response to the disease, may lead to changes that leave ALL survivors at risk for problems with executive functioning and processing speed later,” corresponding author Kevin Krull, PhD, a member of the St. Jude Department of Epidemiology and Cancer Control, said in a statement.

The researchers analyzed 5 CSF biomarkers—myelin basic protein, nerve growth factor, total and phosphorylated tau protein, glial fibrillary acidic protein, and chitotriosidase—and found that levels of 2 of them—myelin basic protein, the biomarker for myelin degradation, and glial fibrillary acidic protein, a biomarker for astrogliosis—were elevated at baseline. Meanwhile, nerve growth factor, a biomarker for neuronal damage, and chitotriosidase, a biomarker for neuroinflammantion, increased as treatment progressed.

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