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Petrykey K, Lippé S, Sultan S, Robaey P, Drouin S, Affret-Bertout L, Beaulieu P, St-Onge P, Baedke JL, Yasui Y, Hudson MM, Laverdière C, Sinnett D, Krajinovic M. Genetic Factors and Long-term Treatment-Related Neurocognitive Deficits, Anxiety, and Depression in Childhood Leukemia Survivors: An Exome-Wide Association Study. Cancer Epidemiol Biomarkers Prev 2024; 33:234-243. [PMID: 38051303 PMCID: PMC10903523 DOI: 10.1158/1055-9965.epi-23-0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/23/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND An increased risk of neurocognitive deficits, anxiety, and depression has been reported in childhood cancer survivors. METHODS We analyzed associations of neurocognitive deficits, as well as anxiety and depression, with common and rare genetic variants derived from whole-exome sequencing data of acute lymphoblastic leukemia (ALL) survivors from the PETALE cohort. In addition, significant associations were assessed using stratified and multivariable analyses. Next, top-ranking common associations were analyzed in an independent SJLIFE replication cohort of ALL survivors. RESULTS Significant associations were identified in the entire discovery cohort (N = 229) between the AK8 gene and changes in neurocognitive function, whereas PTPRZ1, MUC16, TNRC6C-AS1 were associated with anxiety. Following stratification according to sex, the ZNF382 gene was linked to a neurocognitive deficit in males, whereas APOL2 and C6orf165 were associated with anxiety and EXO5 with depression. Following stratification according to prognostic risk groups, the modulatory effect of rare variants on depression was additionally found in the CYP2W1 and PCMTD1 genes. In the replication SJLIFE cohort (N = 688), the male-specific association in the ZNF382 gene was not significant; however, a P value<0.05 was observed when the entire SJLIFE cohort was analyzed. ZNF382 was significant in males in the combined cohorts as shown by meta-analyses as well as the depression-associated gene EXO5. CONCLUSIONS Further research is needed to confirm whether the current findings, along with other known risk factors, may be valuable in identifying patients at increased risk of these long-term complications. IMPACT Our results suggest that specific genes may be related to increased neuropsychological consequences.
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Affiliation(s)
- Kateryna Petrykey
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pharmacology and Physiology, Université de Montréal (Quebec), Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Psychology, Université de Montréal (Quebec), Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Psychology, Université de Montréal (Quebec), Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Children’s Hospital of Eastern Ontario, Ottawa (Ontario), Canada
- Department of Psychiatry, Université de Montréal (Quebec), Canada
- Department of Psychiatry, University of Ottawa (Ontario), Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
| | | | - Patrick Beaulieu
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
| | - Pascal St-Onge
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
| | - Jessica L. Baedke
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis (TN), USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis (TN), USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis (TN), USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis (TN), USA
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pediatrics, Université de Montréal (Quebec), Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pediatrics, Université de Montréal (Quebec), Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montreal (Quebec), Canada
- Department of Pharmacology and Physiology, Université de Montréal (Quebec), Canada
- Department of Pediatrics, Université de Montréal (Quebec), Canada
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2
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Behavioral and Emotional Functioning of Children and Adolescents at the End of Treatment for Acute Lymphoblastic Leukemia Compared to Healthy Peers. J Clin Psychol Med Settings 2022; 29:421-431. [PMID: 35113314 DOI: 10.1007/s10880-021-09840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
This study describes the behavioral and emotional adjustment of 77 children and adolescents 3 months post-treatment for acute lymphoblastic leukemia (ALL), compared to 52 age and sex-matched healthy peers. Parents, teachers, and self-report ratings on the Behavioral Assessment System for Children, Second Edition (BASC-2) were utilized to measure psychological function. While overall mean scores were in the average range for both groups, parents and teachers rated patients higher on behavior symptoms, internalizing problems and adaptive skill difficulties. No significant differences between groups were observed on self-report, and inter-rater correlations were low to moderate. For the ALL group, maternal university completion was associated with elevations on parent report of behavioral problems, while no other factors predicted either parent or teacher report on other scales. Findings indicate that a subset of patients will require specialist psychosocial support to optimise their adjustment following treatment completion.
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Assessment of Executive Functions after Treatment of Childhood Acute Lymphoid Leukemia: a Systematic Review. Neuropsychol Rev 2020; 30:386-406. [PMID: 32720195 DOI: 10.1007/s11065-020-09446-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/09/2020] [Indexed: 01/18/2023]
Abstract
Individuals treated for childhood acute lymphoblastic leukemia (ALL) have a high survival rate. This fact, however, may lead to neurocognitive impairments in survivors, as shown in some studies. The prefrontal cortex and executive functions seem to be particularly vulnerable due to the late maturation in the development process. Executive impairments have been associated with poorer quality of life in childhood cancer survivors. A systematic review was carried out with studies that assessed executive functions in childhood ALL survivors.\ Studies were collected from five electronic databases: MEDLINE (PubMed); PsycInfo; WebOfScience; LILACS and IBECS. Eighty-four studies were retrieved from the database search, of which 50 were read in full and 26 met the inclusion criteria. The studies were heterogeneous as to the instruments used to assess executive function, the skills assessed and the comparison methods. Despite some discrepancies, ALL survivors seem to exhibit poorer executive functioning than typical controls, but this result did not hold true when subjects were compared to normative mean. Changes in brain structure and dynamics resulting from the disease itself, the toxicity of the treatment and difficulties in coping with the stress during treatment may be related to executive impairments in ALL survivors. Discussion proposed standardized methods and measures for assessing executive functioning in children during and after ALL treatment.
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4
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Petrykey K, Lippé S, Robaey P, Sultan S, Laniel J, Drouin S, Bertout L, Beaulieu P, St-Onge P, Boulet-Craig A, Rezgui A, Yasui Y, Sapkota Y, Krull KR, Hudson MM, Laverdière C, Sinnett D, Krajinovic M. Influence of genetic factors on long-term treatment related neurocognitive complications, and on anxiety and depression in survivors of childhood acute lymphoblastic leukemia: The Petale study. PLoS One 2019; 14:e0217314. [PMID: 31181069 PMCID: PMC6557490 DOI: 10.1371/journal.pone.0217314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/08/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A substantial number of survivors of childhood acute lymphoblastic leukemia suffer from treatment-related late adverse effects including neurocognitive impairment. While multiple studies have described neurocognitive outcomes in childhood acute lymphoblastic leukemia (ALL) survivors, relatively few have investigated their association with individual genetic constitution. METHODS To further address this issue, genetic variants located in 99 genes relevant to the effects of anticancer drugs and in 360 genes implicated in nervous system function and predicted to affect protein function, were pooled from whole exome sequencing data of childhood ALL survivors (PETALE cohort) and analyzed for an association with neurocognitive complications, as well as with anxiety and depression. Variants that sustained correction for multiple testing were genotyped in entire cohort (n = 236) and analyzed with same outcomes. RESULTS Common variants in MTR, PPARA, ABCC3, CALML5, CACNB2 and PCDHB10 genes were associated with deficits in neurocognitive tests performance, whereas a variant in SLCO1B1 and EPHA5 genes was associated with anxiety and depression. Majority of associations were modulated by intensity of treatment. Associated variants were further analyzed in an independent SJLIFE cohort of 545 ALL survivors. Two variants, rs1805087 in methionine synthase, MTR and rs58225473 in voltage-dependent calcium channel protein encoding gene, CACNB2 are of particular interest, since associations of borderline significance were found in replication cohort and remain significant in combined discovery and replication groups (OR = 1.5, 95% CI, 1-2.3; p = 0.04 and; OR = 3.7, 95% CI, 1.25-11; p = 0.01, respectively). Variant rs4149056 in SLCO1B1 gene also deserves further attention since previously shown to affect methotrexate clearance and short-term toxicity in ALL patients. CONCLUSIONS Current findings can help understanding of the influence of genetic component on long-term neurocognitive impairment. Further studies are needed to confirm whether identified variants may be useful in identifying survivors at increased risk of these complications.
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Affiliation(s)
- Kateryna Petrykey
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Laniel
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Patrick Beaulieu
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Pascal St-Onge
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Aubrée Boulet-Craig
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Aziz Rezgui
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
| | - Yutaka Yasui
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Yadav Sapkota
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Kevin R. Krull
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Melissa M. Hudson
- Epidemiology and Cancer Control Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
- Oncology Department, St. Jude Children’s Research Hospital, Memphis, TN, United States of America
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
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5
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Anestin AS, Lippé S, Robaey P, Bertout L, Drouin S, Krajinovic M, Michon B, Rondeau É, Samoilenko M, Laverdière C, Sinnett D, Sultan S. Psychological risk in long-term survivors of childhood acute lymphoblastic leukemia and its association with functional health status: A PETALE cohort study. Pediatr Blood Cancer 2018; 65:e27356. [PMID: 30084222 DOI: 10.1002/pbc.27356] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent research has suggested that long-term pediatric cancer survivors were at risk of important physical and psychological morbidities. To date, we do not know to what extent functional health status contributes to psychological risk and which domains are most important. The aim of this study was to systematically explore which functional domain could explain anxiety, depression, and distress symptoms. PROCEDURE We used data available for 105 adolescents and 182 adults successfully treated for childhood acute lymphoblastic leukemia at two Canadian sites part of the PETALE cohort. Participants were ≥5 years postdiagnosis, aged 22 ± 6 years, 52% female, and 49% acute lymphoblastic leukemia high-risk status. The contribution of health functional status (15D/16D questionnaires) to self-reported anxiety, depression, and distress (Beck scales and distress thermometer) was evaluated using adjusted logistic regression models. RESULTS Prevalence rates found for mild-severe anxiety, depression, and distress were 14%, 21%, and 30% among adolescents and 27%, 20%, and 19% among adults. Frequent health domains associated with psychological risk were sleeping and breathing in adolescents, and vitality/fatigue, discomfort/symptoms, mental function, and sleeping in adults. Mental function was systematically associated with psychological risk across age groups (median OR = 10.00, 95% CI 3.01-33.71). Exploratory mediation bootstrapping analyses suggested that the effect on psychological risk of overall health status and mental function problems was partly explained by social/work/school functioning. CONCLUSION The results identified important functional health domains that could be targeted for interventions preventing psychological risk: vitality/fatigue, discomfort/symptoms, sleeping, and mental function issues. Health domains probably affect mood partly by limiting social/work/school functioning.
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Affiliation(s)
- Annélie S Anestin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Sarah Lippé
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Robaey
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Laurence Bertout
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Simon Drouin
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Maja Krajinovic
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Bruno Michon
- Quebec University Health Center (QUHC), Montréal, Québec, Canada
| | - Émélie Rondeau
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada
| | - Mariia Samoilenko
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Université du Québec à Montréal (UQAM), Montréal, Québec, Canada
| | - Caroline Laverdière
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Daniel Sinnett
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | - Serge Sultan
- Sainte-Justine University Health Center (SJUHC), Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
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6
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Moore IMK, Koerner KM, Gundy PM, Montgomery DW, Insel KC, Harris LL, Taylor OA, Hockenberry MJ. Changes in Oxidant Defense, Apoptosis, and Cognitive Abilities During Treatment for Childhood Leukemia. Biol Res Nurs 2018. [PMID: 29514461 DOI: 10.1177/1099800418763124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aggressive central nervous system (CNS)-directed treatment for acute lymphoblastic leukemia (ALL), the most prevalent cancer among children and adolescents, prevents metastasis of leukemia cells into the brain. Up to 60% of survivors experience cognitive problems, but knowledge about risk factors for and mechanisms of neurologic injury is lacking. Objectives of the present study were to (1) quantify changes in oxidant defense and apoptosis over the course of ALL therapy and (2) elucidate risk factors for long-term cognitive problems. The sample included 71 children with ALL. Cerebrospinal fluid (CSF) samples were collected at diagnosis and during intrathecal chemotherapy administration. Oxidant defense was measured by reduced glutathione (GSH), oxidized glutathione (GSSG), and the ratio of GSH:GSSG. Apoptosis was measured by activity of several cysteine-dependent aspartate-specific protease (abbreviated as caspase) enzymes that initiate (caspases 8 and 9) or execute (caspases 3/7) apoptosis. Cognitive abilities were assessed by standardized measures of short-term memory, visual-motor integration, and attention 3 years after ALL diagnosis. GSH and GSSG concentration increased significantly during ALL therapy, and a low GSH:GSSG ratio was indicative of an oxidized extracellular environment. Caspase enzyme activity increased significantly, and caspases 3/7 activity was significantly and negatively associated with performance on measures of cognitive abilities. Younger age at time of ALL diagnosis was associated with some measures of attention. Efflux of glutathione into CSF maintains oxidant defense by scavenging free radicals and other reactive oxygen species and is an early event in apoptosis. These mechanisms may be involved in neurologic injury associated with CNS-directed treatment and subsequent cognitive problems.
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Affiliation(s)
- Ida M Ki Moore
- 1 College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Kari M Koerner
- 1 College of Nursing, The University of Arizona, Tucson, AZ, USA
| | | | | | - Kathleen C Insel
- 1 College of Nursing, The University of Arizona, Tucson, AZ, USA
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7
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Abstract
BACKGROUND Acute lymphoblastic leukemia is the most common pediatric cancer, and survival approaches 90%. Acute lymphoblastic leukemia survivors are more likely than healthy peers or siblings to experience academic underachievement, yet little is known about neurocognitive predictors of academic outcomes. OBJECTIVES Objectives were to compare neurocognitive abilities to age-adjusted standardized norms, examine change over time in neurocognitive abilities, and establish neurocognitive predictors of academic outcomes. METHODS Seventy-one children were followed over the course of therapy. Cognitive abilities were assessed during induction when the child was in remission (baseline) and annually for 3 years (years 1, 2, and 3). Reading and mathematics abilities were assessed at year 3. RESULTS Fine motor dexterity was significantly below age-adjusted norms at all data points but showed improvement over time. Baseline visual-motor integration was within the reference range but significantly declined by year 3, and mean scores at years 2 and 3 were significantly below age-adjusted norms. Verbal short-term memory was significantly below age-adjusted norms at all assessments. Visual-motor integration predicted reading and mathematics abilities. Verbal short-term memory predicted reading abilities, and visual short-term memory predicted mathematics abilities. CONCLUSIONS Central nervous system-directed therapy is associated with specific neurocognitive problems. Visual-spatial skills and verbal and visual short-term memory predict academic outcomes. IMPLICATIONS FOR PRACTICE Early assessment of visual-spatial perception and short-term memory can identify children at risk of academic problems. Children who are at risk of academic problems could benefit from a school-based individual educational program and/or educational intervention.
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8
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Feasibility of baseline neurocognitive assessment using Cogstate during the first month of therapy for childhood leukemia. Support Care Cancer 2016; 25:449-457. [PMID: 27726029 DOI: 10.1007/s00520-016-3422-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Neurocognitive impairment is frequently observed among acute lymphoblastic leukemia (ALL) survivors within the domains of intelligence, attention, processing speed, working memory, learning, and memory. However, few have investigated treatment-induced changes in neurocognitive function during the first months of treatment. Additionally, dysfunction during treatment may be preceded by changes in biomarkers measured within cerebrospinal fluid (CSF). Identification of acute declines in neurocognitive function, as well as predictive genotypes or biomarkers, could guide therapeutic trials of protective interventions. METHODS This study collects CSF while prospectively assessing neurocognitive functioning (working memory, executive function, learning, processing speed, and attention) of ALL patients using the Cogstate computerized battery at six time points during and after the 2 years of leukemia treatment on a Dana-Farber Cancer Institute ALL Consortium trial. RESULTS Baseline data collected during the first 3 weeks of induction chemotherapy indicate reliable data as all subjects (N = 34) completed Cogstate baseline testing, while completion and performance checks indicate that 100 % of subjects completed testing and complied with test requirements. The majority (85 %) exhibited normal function compared with age peers. Preliminary analysis of CSF biomarkers (folate, homocysteine, 8-isoprostane, and myelin basic protein) similarly reveals values at baseline within expected normal ranges. CONCLUSIONS The first month of induction therapy for ALL is a reliable baseline for detecting treatment-induced changes in neurocognitive functioning. Consequently, serial data collection might identify subgroups of ALL patients at increased risk for neurocognitive decline, warranting proactive interventions to improve their level of functioning both during treatment and into survivorship.
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9
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Ahomäki R, Harila-Saari A, Matomäki J, Lähteenmäki PM. Non-graduation after comprehensive school, and early retirement but not unemployment are prominent in childhood cancer survivors-a Finnish registry-based study. J Cancer Surviv 2016; 11:284-294. [PMID: 27714627 DOI: 10.1007/s11764-016-0574-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/20/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to assess neurocognitive and social outcomes after childhood cancer, we explored the educational and vocational attainments of Finnish survivors in comparison to matched population controls. METHODS From national registries, we identified survivors (n = 3243) born from 1960 to 1992 and aged below 16 at cancer diagnosis (years 1964-2009) as well as their controls (n = 16,215). Data on educational achievements, yearly income, employment status, and retirement were retrieved from Statistics Finland. RESULTS The median (range) age at study was 28 (17-50) years. The proportion of those with no education after comprehensive school was higher than controls for all the diagnostic groups: brain tumor (BT) (33.5 vs 23.0 %), solid tumor (ST) (25.0 vs 21.4 %), and leukemia/NHL (29.2 vs 23.1 %). Odds ratios (OR) for unemployment were not significantly elevated in any survivor group compared to controls, but OR for being retired was elevated in each survivor group (BT 14.8, ST 2.2, leukemia/NHL 4.0). Irradiation significantly increased that OR only in BT survivors. Leukemia/NHL survivors treated after 1992 had lower risk for early retirement (OR 0.6) compared to those diagnosed earlier. CONCLUSIONS Survivors had higher frequencies than controls for lacking further education after comprehensive school. Unemployment was not common, but risk for early retirement was significantly increased in each three survivor group. IMPLICATIONS FOR CANCER SURVIVORS Reassuring is that premature retirement was less common during the most recent treatment era. Screening and follow-up of psychosocial performance more effectively might be essential, and there is a need for studies on possibility for effective rehabilitation of the survivors.
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Affiliation(s)
- Ritva Ahomäki
- Department of Pediatrics and Adolescence, Turku University Hospital, Tuijulankatu 24, 20540, Turku, Finland.
| | - Arja Harila-Saari
- Childhood Cancer Research Unit, Stockholm, Sweden.,Department of Pediatrics and Adolescence, Oulu University Hospital, Astrid Lindgren Children's Hospital, Turku, Finland
| | - Jaakko Matomäki
- The University of Turku, Turun Yliopisto, 20014, Turku, Finland
| | - Päivi M Lähteenmäki
- Department of Pediatrics and Adolescence, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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10
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Pépin AJ, Cloutier-Bergeron A, Malboeuf-Hurtubise C, Achille M, Krajinovic M, Laverdière C, Lippé S, Marcoux S, Sinnett D, Sultan S. Adverse neuropsychological effects associated with cumulative doses of corticosteroids to treat childhood acute lymphoblastic leukemia: A literature review. Crit Rev Oncol Hematol 2016; 107:138-148. [PMID: 27823641 DOI: 10.1016/j.critrevonc.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/11/2016] [Accepted: 09/06/2016] [Indexed: 01/07/2023] Open
Abstract
Corticosteroids (CS) are an essential component of childhood acute lymphoblastic leukemia treatments (cALL). Although there is evidence that daily doses of CS can have neuropsychological effects, few studies have investigated the role of cumulative doses of CS in short- and long-term neuropsychological effects in cALL. The aims of this review were to identify the measures used for documenting adverse neuropsychological effects (ANEs) of CS treatment and to study the association between cumulative doses of CS and the presence of ANEs. Twenty-two articles met the inclusion criteria. A variety of measures were used to evaluate outcomes in the domains of emotion, behaviour, neurocognition, and fatigue/sleep. The results suggest that we cannot conclude in favour of an association between the cumulative dosage of CS and ANEs. Yet, several factors including the heterogeneity of measures used to evaluate outcomes and reporting biases may limit the scope of the results. We offer several recommendations that could help improve the future published evidence on ANEs in relation to CS treatment in cALL.
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Affiliation(s)
- A J Pépin
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada.
| | | | | | | | - M Krajinovic
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - C Laverdière
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Lippé
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Marcoux
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - D Sinnett
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada
| | - S Sultan
- Université de Montréal, Canada; CHU Sainte-Justine, Montreal, Canada.
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11
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Cole PD. Does genetic susceptibility increase risk for neurocognitive decline among patients with acute lymphoblastic leukemia? Future Oncol 2015; 11:1855-8. [PMID: 26161922 DOI: 10.2217/fon.15.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Peter D Cole
- Albert Einstein College of Medicine, 1225 Morris Park Avenue, Van Etten Building, Room VE 6A03, Bronx, NY 10461, USA.,The Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467, USA
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12
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Cole PD, Finkelstein Y, Stevenson KE, Blonquist TM, Vijayanathan V, Silverman LB, Neuberg DS, Sallan SE, Robaey P, Waber DP. Polymorphisms in Genes Related to Oxidative Stress Are Associated With Inferior Cognitive Function After Therapy for Childhood Acute Lymphoblastic Leukemia. J Clin Oncol 2015; 33:2205-11. [PMID: 25987702 DOI: 10.1200/jco.2014.59.0273] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Survivors of childhood acute lymphoblastic leukemia (ALL) exhibit increased rates of neurocognitive deficits. This study was conducted to test whether interpatient variability in neurocognitive outcomes can be explained by polymorphisms in candidate genes conferring susceptibility to neurocognitive decline. METHODS Neurocognitive testing was conducted in 350 pediatric leukemia survivors, treated on Dana-Farber Cancer Institute ALL Consortium Protocols 95-01 or 00-01. Genomic DNA was isolated from bone marrow collected at remission. Candidate polymorphisms were selected on the basis of prior literature, targeting genes related to drug metabolism, oxidative damage, altered neurotransmission, neuroinflammation, and folate physiology. Single nucleotide polymorphisms were detected using either a customized multiplexed Sequenom MassARRAY assay or polymerase chain reaction-based allelic discrimination assays. Multivariable logistic regression models were used to estimate the effects of genotype on neurocognitive outcomes, adjusted for the effects of demographic and treatment variables. False-discovery rate correction was made for multiple hypothesis testing, indicated as a Q value. RESULTS Inferior cognitive or behavioral outcomes were associated with polymorphisms in three genes related to oxidative stress and/or neuroinflammation: NOS3 (IQ, Q = 0.008; Vocabulary Q = 0.011; Matrix Reasoning Q = 0.008), SLCO2A1 (IQ Q = 0.043; Digit Span Q = 0.006; Block Design Q = 0.076), and COMT (Behavioral Assessment System for Children-2 Attention Q = 0.080; and Hyperactivity Q = 0.084). Survivors homozygous for NOS3 894T, with at least one SLCO2A1 variant G allele or with at least one GSTP1 variant allele, had lower mean estimated IQ scores than those without these genotypes. CONCLUSION These data are consistent with the hypothesis that oxidative damage contributes to chemotherapy-associated neurocognitive decline among children with leukemia.
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Affiliation(s)
- Peter D Cole
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA.
| | - Yaron Finkelstein
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Kristen E Stevenson
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Traci M Blonquist
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Veena Vijayanathan
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Lewis B Silverman
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Donna S Neuberg
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Stephen E Sallan
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Philippe Robaey
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Deborah P Waber
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
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Luxton J, Brinkman TM, Kimberg C, Robison LL, Hudson MM, Krull KR. Utility of the N-back task in survivors of childhood acute lymphoblastic leukemia. J Clin Exp Neuropsychol 2014; 36:944-55. [PMID: 25252969 PMCID: PMC4355950 DOI: 10.1080/13803395.2014.957168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The N-back task is often used in functional brain imaging studies to activate working memory networks; however, limited information is available on its association to clinical outcomes in children or cancer survivors. A total of 137 survivors of acute lymphoblastic leukemia (ALL; mean current age = 14.3 years, SD = 4.8; time since diagnosis = 7.6 years, SD = 1.6) completed the N-back task and comprehensive neurocognitive testing, including standardized measures of attention, processing speed, and working memory. Results indicated that females demonstrated significantly slower reaction times (0-back p = .02; 1-back p = .03) than males. Survivors <15 years old at the time of testing demonstrated a significant decrease in accuracy as working memory load increased compared to survivors ≥15 years old (p < .001). Performance on the N-back task was associated with nonverbal working memory (rs = .56, p < .001) in survivors ≥15 years of age. For younger survivors, N-back performance was more strongly associated with attention skills. Results suggest the N-back assesses different cognitive constructs at younger compared to older childhood ages. These age differences should be considered in interpreting functional brain imaging results.
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Affiliation(s)
- Joshua Luxton
- a Department of Epidemiology and Cancer Control , St. Jude Children's Research Hospital , TN , USA
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Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014; 106:dju186. [PMID: 25080574 DOI: 10.1093/jnci/dju186] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Survivors of childhood cancer frequently experience cancer-related cognitive dysfunction, commonly months to years after treatment for pediatric brain tumors, acute lymphoblastic leukemia (ALL), or tumors involving the head and neck. Risk factors for cancer-related cognitive dysfunction include young age at diagnosis, treatment with cranial irradiation, use of parenteral or intrathecal methotrexate, female sex, and pre-existing comorbidities. Limiting use and reducing doses and volume of cranial irradiation while intensifying chemotherapy have improved survival and reduced the severity of cognitive dysfunction, especially in leukemia. Nonetheless, problems in core functional domains of attention, processing speed, working memory and visual-motor integration continue to compromise quality of life and performance. We review the epidemiology, pathophysiology and assessment of cancer-related cognitive dysfunction, the impact of treatment changes for prevention, and the broad strategies for educational and pharmacological interventions to remediate established cognitive dysfunction following childhood cancer. The increased years of life saved after childhood cancer warrants continued study toward the prevention and remediation of cancer-related cognitive dysfunction, using uniform assessments anchored in functional outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL).
| | - Nicole J Ullrich
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Megan J Whelen
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Beverly J Lange
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
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15
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Kesler SR, Gugel M, Pritchard-Berman M, Lee C, Kutner E, Hosseini SH, Dahl G, Lacayo N. Altered resting state functional connectivity in young survivors of acute lymphoblastic leukemia. Pediatr Blood Cancer 2014; 61:1295-9. [PMID: 24619953 PMCID: PMC4028071 DOI: 10.1002/pbc.25022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/14/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chemotherapy treatment for pediatric acute lymphoblastic leukemia (ALL) has been associated with long-term cognitive impairments in some patients. However, the neurobiologic mechanisms underlying these impairments, particularly in young survivors, are not well understood. This study aimed to examine intrinsic functional brain connectivity in pediatric ALL and its relationship with cognitive status. PROCEDURE We obtained resting state functional magnetic resonance imaging (rsfMRI) and cognitive testing data from 15 ALL survivors age 8-15 years and 14 matched healthy children. The ALL group had a history of intrathecal chemotherapy treatment but were off-therapy for at least 6 months at the time of enrollment. We used seed-based analyses to compare intrinsic functional brain network connectivity between the groups. We also explored correlations between connectivity and cognitive performance, demographic, medical, and treatment variables. RESULTS We demonstrated significantly reduced connectivity between bilateral hippocampus, left inferior occipital, left lingual gyrus, bilateral calcarine sulcus, and right amygdala in the ALL group compared to controls. The ALL group also showed regions of functional hyperconnectivity including right lingual gyrus, precuneus, bilateral superior occipital lobe, and right inferior occipital lobe. Functional hypoconnectivity was associated with reduced cognitive function as well as younger age at diagnosis in the ALL group. CONCLUSIONS This is the first study to demonstrate that intrinsic functional brain connectivity is disrupted in pediatric ALL following chemotherapy treatment. These results help explain cognitive dysfunction even when objective test performance is seemingly normal. Children diagnosed at a younger age may show increased vulnerability to altered functional brain connectivity.
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Affiliation(s)
- Shelli R. Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
,Correspondence to: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, MC5795, Stanford, CA 94305-5795.
| | - Meike Gugel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Mika Pritchard-Berman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Clement Lee
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Emily Kutner
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - S.M. Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Gary Dahl
- Department of Pediatrics—Hematology/Oncology, Lucile Packard Children’s Hospital, Palo Alto, California
| | - Norman Lacayo
- Department of Pediatrics—Hematology/Oncology, Lucile Packard Children’s Hospital, Palo Alto, California
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16
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Cole PD, Vijayanathan V, Ali NF, Wagshul ME, Tanenbaum EJ, Price J, Dalal V, Gulinello ME. Memantine protects rats treated with intrathecal methotrexate from developing spatial memory deficits. Clin Cancer Res 2013; 19:4446-54. [PMID: 23833301 DOI: 10.1158/1078-0432.ccr-13-1179] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To test whether memantine can prevent methotrexate-induced cognitive deficits in a preclinical model. EXPERIMENTAL DESIGN After noting that methotrexate exposure induces prolonged elevations of the glutamate analog homocysteic acid (HCA) within cerebrospinal fluid, we tested whether intrathecal injection of HCA would produce memory deficits similar to those observed after intrathecal methotrexate. We then tested whether memantine, an antagonist of the N-methyl-d-aspartate (NMDA) subclass of glutamate receptors, could protect animals treated with clinically relevant doses of intrathecal methotrexate against developing memory deficits. Finally, we asked whether memantine affected this pathway beyond inhibiting the NMDA receptor by altering expression of the NMDA receptor or affecting concentrations of HCA or glutamate within the central nervous system. RESULTS Four intrathecal doses of methotrexate induced deficits in spatial memory, persisting at least one month following the final injection. Intrathecal HCA was sufficient to reproduce this deficit. Concurrent administration of memantine during the period of methotrexate exposure was protective, decreasing the incidence of methotrexate-induced spatial memory deficits from 56% to 20% (P < 0.05). Memantine neither altered expression of NMDA receptors within the hippocampus nor blunted the methotrexate-induced increases in glutamate or HCA. CONCLUSIONS Excitotoxic glutamate analogs including HCA contribute to cognitive deficits observed after intrathecal methotrexate. Memantine, an NMDA receptor antagonist, reduces the incidence of cognitive deficits in rats treated with intrathecal methotrexate, and may therefore benefit patients with cancer receiving similar treatment.
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Affiliation(s)
- Peter D Cole
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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17
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Sung L, Zaoutis T, Ullrich NJ, Johnston D, Dupuis L, Ladas E. Children's Oncology Group's 2013 blueprint for research: cancer control and supportive care. Pediatr Blood Cancer 2013; 60:1027-30. [PMID: 23255159 PMCID: PMC4447629 DOI: 10.1002/pbc.24426] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/09/2012] [Indexed: 11/07/2022]
Abstract
In cancer control research, the objective is to reduce overall morbidity and mortality by decreasing acute and delayed treatment-related toxicities in all children with cancer. To date, the Children's Oncology Group (COG) has focused on infection, neurocognition, quality of life (QoL), and nutrition/antiemetics. COG is conducting randomized controlled trials (RCTs) to determine prophylaxis strategies that will reduce infections in high-risk populations. Two RCTs are determining if modafinil or computerized cognitive training improve cognitive functioning in pediatric brain tumor patients. QoL is being assessed in acute leukemia patients. Improved supportive care outcomes will only occur when the most effective interventions are established.
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Affiliation(s)
- Lillian Sung
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Theo Zaoutis
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicole J. Ullrich
- Department of Neurology, Boston Children’s Hospital and Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna Johnston
- Department of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lee Dupuis
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elena Ladas
- Department of Pediatric Oncology, Columbia University Medical Center, New York, New York
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Abstract
PURPOSE OF REVIEW Modern cancer therapies have allowed for a dramatic increase in the survival rates in both children and adults. However, a frequent and unfortunate side-effect of cancer therapy is a long-term decline in neurocognitive function. Specifically, cranial radiation therapy markedly alters memory processes, while chemotherapeutic agents are correlated with deficits in attention, concentration, and speed of information processing. Here, we describe the putative cellular etiologies of cancer treatment-induced cognitive decline, with an emphasis on the role of neural stem and precursor cell dysfunction. RECENT FINDINGS New studies highlight the lasting effects of chemotherapy on memory, executive function, attention, and speed of information processing up to 20 years following chemotherapy. Cognitive decrements are associated with decreased white-matter integrity as well as alterations in stem cell function in humans and rodent models of cancer therapy. Genetic polymorphisms may underlie differential sensitivity of certain individuals to the neurological consequences of chemotherapy. Increasing data support the concept that disruption of normal neural stem and precursor cell function is an important causative factor for the cognitive deficits that result from cancer therapy in both children and adults. SUMMARY Further studies are needed to elucidate the role of chemotherapy on cell-intrinsic processes and cellular microenvironments. Further, the effects of the new generation of targeted molecular therapies on neural stem and progenitor cell function remains largely untested. Understanding the mechanisms behind cancer therapy-induced damage to neural stem and precursor cell populations will elucidate neuroprotective and cell replacement strategies aimed at preserving cognition after cancer therapy.
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