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De Alcubierre D, Ferrari D, Mauro G, Isidori AM, Tomlinson JW, Pofi R. Glucocorticoids and cognitive function: a walkthrough in endogenous and exogenous alterations. J Endocrinol Invest 2023; 46:1961-1982. [PMID: 37058223 PMCID: PMC10514174 DOI: 10.1007/s40618-023-02091-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE The hypothalamic-pituitary-adrenal (HPA) axis exerts many actions on the central nervous system (CNS) aside from stress regulation. Glucocorticoids (GCs) play an important role in affecting several cognitive functions through the effects on both glucocorticoid (GR) and mineralocorticoid receptors (MR). In this review, we aim to unravel the spectrum of cognitive dysfunction secondary to derangement of circulating levels of endogenous and exogenous glucocorticoids. METHODS All relevant human prospective and retrospective studies published up to 2022 in PubMed reporting information on HPA disorders, GCs, and cognition were included. RESULTS Cognitive impairment is commonly found in GC-related disorders. The main brain areas affected are the hippocampus and pre-frontal cortex, with memory being the most affected domain. Disease duration, circadian rhythm disruption, circulating GCs levels, and unbalanced MR/GR activation are all risk factors for cognitive decline in these patients, albeit with conflicting data among different conditions. Lack of normalization of cognitive dysfunction after treatment is potentially attributable to GC-dependent structural brain alterations, which can persist even after long-term remission. CONCLUSION The recognition of cognitive deficits in patients with GC-related disorders is challenging, often delayed, or mistaken. Prompt recognition and treatment of underlying disease may be important to avoid a long-lasting impact on GC-sensitive areas of the brain. However, the resolution of hormonal imbalance is not always followed by complete recovery, suggesting irreversible adverse effects on the CNS, for which there are no specific treatments. Further studies are needed to find the mechanisms involved, which may eventually be targeted for treatment strategies.
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Affiliation(s)
- D De Alcubierre
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Ferrari
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Mauro
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - J W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK
| | - R Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK.
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van Hulst AM, Grootenhuis MA, Verwaaijen EJ, van Litsenburg RR, Li L, van Zelst BD, Broer L, Pluijm SM, Pieters R, Fiocco M, van den Akker EL, van den Heuvel-Eibrink MM. Unraveling Dexamethasone-Induced Neurobehavioral and Sleep Problems in Children With ALL: Which Determinants Are Important? JCO Precis Oncol 2023; 7:e2200678. [PMID: 37343203 PMCID: PMC10309531 DOI: 10.1200/po.22.00678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE Dexamethasone, the preferred corticosteroid in most treatment protocols for pediatric acute lymphoblastic leukemia (ALL), can induce undesirable side effects. Neurobehavioral and sleep problems are frequently reported, but the interpatient variability is high. We therefore aimed to identify determinants for parent-reported dexamethasone-induced neurobehavioral and sleep problems in pediatric ALL. METHODS Our prospective study included patients with medium-risk ALL and their parents during maintenance treatment. Patients were assessed before and after one 5-day dexamethasone course. Primary end points were parent-reported dexamethasone-induced neurobehavioral and sleep problems, measured with the Strengths and Difficulties Questionnaire and Sleep Disturbance Scale for Children, respectively. Analyzed determinants included patient and parent demographics, disease and treatment characteristics, parenting stress (Parenting Stress Index and Distress Thermometer for Parents), dexamethasone pharmacokinetics, and genetic variation (candidate single-nucleotide polymorphisms rs41423247 and rs4918). Statistically significant determinants identified in univariable logistic regression analyses were incorporated in a multivariable model. RESULTS We included 105 patients: median age was 5.4 years (range, 3.0-18.8) and 61% were boys. Clinically relevant dexamethasone-induced neurobehavioral and sleep problems were reported by parents in 70 (67%) and 61 (59%) patients, respectively. In our multivariable regression models, we identified parenting stress as a significant determinant for parent-reported neurobehavioral (odds ratio [OR], 1.16; 95% CI, 1.07 to 1.26) and sleep problems (OR, 1.06; 95% CI, 1.02 to 1.10). Furthermore, parents who experienced more stress before start of a dexamethasone course reported more sleep problems in their child (OR, 1.16; 95% CI, 1.02 to 1.32). CONCLUSION We identified parenting stress, and not dexamethasone pharmacokinetics, genetic variation, patient/parent demographics, or disease/treatment characteristics, as a significant determinant for parent-reported dexamethasone-induced neurobehavioral and sleep problems. Parenting stress may be a modifiable target to reduce these problems.
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Affiliation(s)
| | | | | | | | - Letao Li
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bertrand D. van Zelst
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Rob Pieters
- Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Marta Fiocco
- Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
- Mathematical Institute, Leiden University, Leiden, the Netherlands
- Department of Biomedical Data Science, Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Erica L.T. van den Akker
- Department of Pediatric Endocrinology, Erasmus MC- Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marry M. van den Heuvel-Eibrink
- Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
- Child Health, UMCU-Wilhelmina Children's Hospital, Utrecht, the Netherlands
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Fatigue trajectories during pediatric ALL therapy are associated with fatigue after treatment: a national longitudinal cohort study. Support Care Cancer 2023; 31:1. [PMID: 36512099 PMCID: PMC9747814 DOI: 10.1007/s00520-022-07456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Fatigue is one of the most prevalent and distressing symptoms reported by survivors of childhood cancer. There is currently a lack of longitudinal studies on cancer-related fatigue, and especially on the relationship between the course of fatigue during treatment and fatigue at follow-up. The purpose of the current study was therefore to investigate if the course of fatigue during treatment, treatment intensity, serious adverse events, sex, or age at diagnosis are associated with cancer-related fatigue after treatment. METHODS Participants were 92 children and adolescents diagnosed with acute lymphoblastic leukemia (mean age at diagnosis was 6.26 years). Fatigue was measured with PedsQL multidimensional fatigue scale proxy reports 5 months after diagnosis, 12 months after diagnosis, 24 months after diagnosis, and at follow-up 12 months after end of treatment. The effect of patient and treatment characteristics on fatigue reported at follow-up was tested through logistic regression analyses. RESULTS The course of fatigue during treatment significantly predicted fatigue reported at follow-up for general fatigue (p = .038, OR = 9.20), sleep/rest fatigue (p = .011, OR = 15.48), and cognitive fatigue (p < .001, OR = 10.78). None of the other variables were associated with fatigue at follow-up for any of the subscales. CONCLUSIONS The findings demonstrate that fatigue reported during treatment can predict fatigue at follow-up. These results stress the need for longitudinal assessments. Healthcare professionals need to be aware that pediatric patients who are fatigued during treatment need to receive additional attention and timely interventions since cancer-related fatigue will not resolve by itself in the first year after end of treatment.
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Notari L, Kirton R, Mills DS. Psycho-Behavioural Changes in Dogs Treated with Corticosteroids: A Clinical Behaviour Perspective. Animals (Basel) 2022; 12:ani12050592. [PMID: 35268161 PMCID: PMC8909229 DOI: 10.3390/ani12050592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Corticosteroids hormones are central to stress responses and, along with other hormones and neurotransmitters, contribute to the onset of physiological and behavioural changes aimed at helping the animal cope with anticipated demand. Both the human and animal literature suggest that exposure to systemic exogenous corticosteroid treatments can be associated with negative emotional states. In this paper, the potential behavioural effects of exogenous corticosteroid treatment on dogs and other species are discussed to show why consideration should be given to this matter when prescribing these drugs. Abstract Arousal and distress are often important factors in problematic behaviours, and endogenous corticosteroids are important mediators in the associated stress responses. Exogenous corticosteroid treatments have been reported to change behaviour in human patients and laboratory animals, with similar changes also noted in pet dogs. These behaviours not only potentially adversely impact the welfare of the dogs, but also the quality of life of their owners. Indeed, corticosteroids can bias sensitivity towards aversion in dogs. A decrease in behaviours associated with positive affective states, such as play and exploratory behaviours, together with an increase in aggression and barking have also been described in dogs. According to the available literature, human patients with pre-existing psychiatric disorders are more at risk of developing behavioural side effects due to corticosteroid treatments. It is reasonable to consider that the same may happen in dogs with pre-existing behavioural problems. In this paper, the possible behavioural side effects of exogenous corticosteroids are summarised to help inform and support veterinarians prescribing these drugs.
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Affiliation(s)
- Lorella Notari
- Royal Society for the Prevention of Cruelty to Animals (RSPCA), Horsham RH13 9RS, UK;
- Correspondence:
| | - Roxane Kirton
- Royal Society for the Prevention of Cruelty to Animals (RSPCA), Horsham RH13 9RS, UK;
| | - Daniel S. Mills
- School of Life Sciences, University of Lincoln, Lincoln LN6 7TS, UK;
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Alexander TC, Krull KR. Effects of chemotherapy for acute lymphoblastic leukemia on cognitive function in animal models of contemporary protocols: A systematic literature review. Neurosci Biobehav Rev 2021; 129:206-217. [PMID: 34352229 DOI: 10.1016/j.neubiorev.2021.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 10/29/2020] [Accepted: 07/28/2021] [Indexed: 11/20/2022]
Abstract
Survival rates of childhood acute lymphoblastic leukemia (ALL) have improved greatly due to advanced therapies and supportive care. Intrathecal chemotherapy replaced cranial radiation due to radiation-induced neurotoxicity and late-effects. Survivors treated with chemotherapy-only experience neurologic and cognitive problems following cessation of treatment. Very long-term cognitive outcomes remain unclear. Animal models are being generated to assess late-effects of chemotherapy on cognitive function. Although, few address juvenile models of chemotherapy-induced cognitive impairment (CICI) and developing brain, results of this review outline neurocognitive effects of chemotherapy consistent with childhood ALL therapy. Studies demonstrate deficits across cognitive domains including spatial memory, executive function, short-term memory, anxiety and depression. Inflammation, oxidative stress, excitotoxity, and other metabolic disruptions may lead to neurodegeneration associated with cognitive impairment observed in ALL survivors. Interventions directly targeting these mechanisms may prevent and/or promote recovery of cognitive function and improve long-term outcomes. Evidence suggests success of anti-inflammatory and antioxidant treatments in reducing cognitive decline. Animal models provide basis for assessing effects of chemotherapy on neurologic processes to guide future clinical investigations.
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Affiliation(s)
- Tyler C Alexander
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States; Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States.
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van Hulst AM, Peersmann SHM, van den Akker ELT, Schoonmade LJ, van den Heuvel-Eibrink MM, Grootenhuis MA, van Litsenburg RRL. Risk factors for steroid-induced adverse psychological reactions and sleep problems in pediatric acute lymphoblastic leukemia: A systematic review. Psychooncology 2021; 30:1009-1028. [PMID: 33825231 PMCID: PMC8359839 DOI: 10.1002/pon.5654] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/05/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Steroids play an essential role in treating pediatric acute lymphoblastic leukemia (ALL). The downside is that these drugs can cause severe side effects, such as adverse psychological reactions (APRs) and sleep problems, which can compromise health-related quality of life. This study aimed to systematically review literature to identify risk factors for steroid-induced APRs and sleep problems in children with ALL. METHODS A systematic search was performed in six databases. Titles/abstracts were independently screened by two researchers. Data from each included study was extracted based on predefined items. Risk of bias and level of evidence were assessed, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment, Development and Evaluation tool, respectively. RESULTS Twenty-four articles were included. APR measurement ranged from validated questionnaires to retrospective record retrieval, sleep measurement included questionnaires or actigraphy. Overall, quality of evidence was very low. Current evidence suggests that type/dose of steroid is not related to APRs, but might be to sleep problems. Younger patients seem at risk for behavior problems and older patients for sleep problems. No studies describing parental stress or medical history were identified. Genetic susceptibility associations remain to be replicated. CONCLUSIONS Based on the current evidence, conclusions about risk factors for steroid-induced adverse psychological reactions or sleep problems in children with ALL should be drawn cautiously, since quality of evidence is low and methods of measurement are largely heterogeneous. A standardized registration of steroid-induced APRs/sleep problems and risk factors is warranted for further studies in children with ALL.
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Wang X, Guan Y. COVID-19 drug repurposing: A review of computational screening methods, clinical trials, and protein interaction assays. Med Res Rev 2021; 41:5-28. [PMID: 32864815 PMCID: PMC8049524 DOI: 10.1002/med.21728] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/21/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022]
Abstract
The situation of coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving, and medical researchers around the globe are dedicated to finding cures for the disease. Drug repurposing, as an efficient way for drug development, has received a lot of attention. However, the huge amount of studies makes it challenging to keep up to date with the literature on COVID-19 therapeutic development. This review addresses this challenge by grouping the COVID-19 drug repurposing research into three large groups, including clinical trials, computational research, and in vitro protein-binding experiments. Particularly, to facilitate future drug discovery and the creation of effective drug combinations, drugs are organized by their mechanisms of action and reviewed by their efficacy measured by clinical trials. Providing this subtyping information, we hope this review would serve the scientists, clinicians, and the pharmaceutical industry who are looking at the new therapeutics for COVID-19 treatment.
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Affiliation(s)
- Xueqing Wang
- Department of Computational Medicine and Bioinformatics, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Yuanfang Guan
- Department of Computational Medicine and Bioinformatics, Michigan Medicine, University of Michigan, Ann Arbor, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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8
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Steur LMH, Kaspers GJL, van Someren EJW, van Eijkelenburg NKA, van der Sluis IM, Dors N, van den Bos C, Tissing WJE, Grootenhuis MA, van Litsenburg RRL. The impact of maintenance therapy on sleep-wake rhythms and cancer-related fatigue in pediatric acute lymphoblastic leukemia. Support Care Cancer 2020; 28:5983-5993. [PMID: 32285260 PMCID: PMC7686190 DOI: 10.1007/s00520-020-05444-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
Purpose To assess the impact of maintenance therapy and the additional impact of dexamethasone treatment on cancer-related fatigue and sleep-wake rhythms in pediatric acute lymphoblastic leukemia (ALL) patients and to determine the association between these outcomes. Methods A national cohort of pediatric ALL patients (≥ 2 years) was included (± 1 year post-diagnosis). Patients receiving dexamethasone were assessed twice (assessment with and without dexamethasone). Actigraphy assessments were used to calculate sleep-wake outcomes with nonparametric methods. Cancer-related fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Sleep-wake rhythms and cancer-related fatigue were compared between patients participating in the assessment without dexamethasone and healthy children (linear regression) and between assessments with and without dexamethasone (mixed models). Using linear regression, associations between sleep-wake outcomes and cancer-related fatigue were determined during assessments with and without dexamethasone. Results Responses were collected for 125 patients (113 assessments with and 81 without dexamethasone). The sleep-wake rhythm was less stable (p = 0.03) and less robust (p = 0.01), with lower physical activity levels (p < 0.001) and higher cancer-related fatigue levels (p < 0.001) in ALL patients compared to healthy children. Physical activity was lower (p = 0.001) and cancer-related fatigue more severe (p ≤ 0.001) during assessments with dexamethasone compared to without dexamethasone. Sleep-wake outcomes were significantly associated with cancer-related fatigue during periods without dexamethasone, but not during periods with dexamethasone. Conclusion Sleep-wake rhythms are disturbed, physical activity levels lower, and cancer-related fatigue levels higher during maintenance therapy. Interventions aimed to enhance sleep-wake rhythms during maintenance therapy could improve cancer-related fatigue. Families should be supported in coping with the additional burden of dexamethasone treatment to improve well-being of ALL patients. Electronic supplementary material The online version of this article (10.1007/s00520-020-05444-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L M H Steur
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - G J L Kaspers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Dutch Childhood Oncology Group, Utrecht, The Netherlands
| | - E J W van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (an institute of the Royal Netherlands Academy of Arts and Sciences), Amsterdam, The Netherlands
- Department of Integrative Neurophysiology, Amsterdam Neuroscience, Center for Neurogenomics and Cognitive Research (CNCR), VU University Amsterdam, Amsterdam, The Netherlands
- Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - N K A van Eijkelenburg
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - I M van der Sluis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - N Dors
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C van den Bos
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - W J E Tissing
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
- Department of pediatric oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M A Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - R R L van Litsenburg
- Emma Children's Hospital, Amsterdam UMC, Pediatric Oncology, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, ZH 8D12, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
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Staub Y, Suga Y, Ikawa Y, Tsubouchi K, Hashimoto M, Kawagishi A, Shimada T, Sai Y, Nishimura K, Matsushita R. Detailed assessment and risk factor analysis of corticosteroid-induced psychiatric disorders in pediatric, adolescent, and young adult patients undergoing induction or consolidation therapy for hematologic malignancy. J Oncol Pharm Pract 2019; 26:1041-1051. [PMID: 31635550 DOI: 10.1177/1078155219879992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Corticosteroid-induced psychiatric disorders (CIPDs) represent an adverse effect that can cause severe emotional and behavioral problems. The aim of the present study was to assess the incidence and risk factors of CIPDs. METHODS A retrospective analysis of 92 pediatric and young adult patients with hematologic malignancies was conducted. RESULTS The incidence of CIPDs in patients receiving a treatment regimen with prednisolone or dexamethasone was 64.9% and 77.5%, respectively, both of which were significantly higher than that in patients not receiving corticosteroids. Independent risk factors and adjusted odds ratios (95% confidence intervals) related to severe CIPD were 2.15 (1.11-4.18) for dexamethasone (using prednisolone as the reference) and 0.81 (0.75-0.87) for age, suggesting that the odds increase with decreasing age. Frequently observed symptoms, respectively in terms of behavioral and emotional problems were defiance, crying, psychomotor excitement, dysphoria, irritability, and depression. To our knowledge, this is the first report to mention the risk factors and characteristics for clinical symptoms of CIPDs during the developmental process. CONCLUSIONS Healthcare professionals should predict and prepare for psychiatric adverse events prior to chemotherapy in the clinical settings, especially in patients in younger age and receiving a treatment regimen with dexamethasone.
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Affiliation(s)
- Yukiko Staub
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yukio Suga
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Yasuhiro Ikawa
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Kiyotaka Tsubouchi
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Mikie Hashimoto
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Atsufumi Kawagishi
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Tsutomu Shimada
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Yoshimichi Sai
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryo Matsushita
- Department of Clinical Pharmacy and Healthcare Sciences, Faculty of Pharmacy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
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Heck SO, Zborowski VA, Quines CB, Nogueira CW. 4,4'-Dichlorodiphenyl diselenide reverses a depressive-like phenotype, modulates prefrontal cortical oxidative stress and dysregulated glutamatergic neurotransmission induced by subchronic dexamethasone exposure to mice. J Psychiatr Res 2019; 116:61-68. [PMID: 31200328 DOI: 10.1016/j.jpsychires.2019.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/04/2019] [Accepted: 05/31/2019] [Indexed: 12/26/2022]
Abstract
Dexamethasone (DEX) is a synthetic agonist of glucocorticoid receptors that has been associated with neurotoxicity and neuropsychiatric diseases. (p-ClPhSe)2 is an organoselenium compound reported to have antioxidant, antidepressant-like, and neuroprotective actions. This study investigated whether antioxidant activity and modulation of the glutamatergic system contribute to the antidepressant-like effect of (p-ClPhSe)2 in mice subchronically exposed to DEX. Swiss mice received intraperitoneal injections of DEX (2 mg/kg) or saline (vehicle) once a day for 21 days. After, the mice received (p-ClPhSe)2 (1-10 mg/kg) or mineral oil (vehicle) by the intragastric route (i.g.) for 7 days. The mice exposed to DEX were treated with fluoxetine (20 mg/kg, i.g.) once a day for 7 days. 24 h after the last treatment, the animals performed the locomotor activity (LMA), tail suspension, and forced swimming tests. Ex vivo assays were performed in samples of prefrontal cortex (PFC). The results show that (p-ClPhSe)2 reversed depressive-like behavioral phenotype induced by DEX without affecting LMA. Further, (p-ClPhSe)2 at all doses reduced ROS levels and increased CAT activity in the PFC of DEX-exposed mice. The highest dose of (p-ClPhSe)2 was effective against the decrease of SOD activity in the PFC of mice exposed to DEX. (p-ClPhSe)2 increased the [3H] glutamate uptake/release and decreased the Na+/K+-ATPase activity as well as the EAAT1 and NMDA R2A protein contents in the PFC of DEX-exposed mice. Regarding the NMDA R2B levels, there was no difference among experimental groups. In conclusion, this study reveals the effectiveness of (p-ClPhSe)2 in reversing the depressive-like phenotype of DEX-exposed mice. In addition, (p-ClPhSe)2 modulated oxidative stress and glutamate neurotransmission in the PFC of mice subchronically exposed to DEX.
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Affiliation(s)
- Suélen Osório Heck
- Laboratory of Synthesis, Reactivity, Pharmacological and Toxicological Evaluation of Organochalcogen Compounds, Department of Biochemistry and Molecular Biology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, 97105-900, Brazil
| | - Vanessa Angonesi Zborowski
- Laboratory of Synthesis, Reactivity, Pharmacological and Toxicological Evaluation of Organochalcogen Compounds, Department of Biochemistry and Molecular Biology, Center of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria, RS, 97105-900, Brazil
| | - Caroline Brandão Quines
- Laboratory of Biochemistry and Toxicology of Caenorhabditis Elegans, Department of Biochemistry, Federal University of Pampa, Campus Uruguaiana, RS, Brazil
| | - Cristina Wayne Nogueira
- Departamento de Bioquímica e Biologia Molecular, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, CEP 97105-900, RS, Brazil.
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Bruzzi P, Bigi E, Predieri B, Bonvicini F, Cenciarelli V, Felici F, Iughetti L. Long-term effects on growth, development, and metabolism of ALL treatment in childhood. Expert Rev Endocrinol Metab 2019; 14:49-61. [PMID: 30596296 DOI: 10.1080/17446651.2019.1561271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION One aim of the long-term care in survivors from acute lymphoblastic leukemia (ALL) during childhood is to avoid or limit complications caused by aggressive therapeutic strategies. AREAS COVERED ALL survivors are a heterogeneous group according to therapeutic protocols. In the last decades, cranial radiotherapy (cRT) has been largely replaced by intrathecal chemotherapy (CT) with a reduction of endocrine sequelae. Published studies are generally difficult to be interpreted because patients were treated according to different risk-adapted protocols and results are conflicting. We perform this review on endocrine long-term effects in childhood ALL survivors focusing on studies published in the last decades. Articles were selected using the following terms (Mesh terms): 'acute lymphoblastic leukemia' AND 'survivors' AND 'childhood' AND 'growth/puberty/fertility/obesity/metabolic syndrome/bone'. EXPERT COMMENTARY Most childhood ALL survivors treated with CT alone attain normal height and have adequate pubertal development. Despite recent protocols improvements, ALL survivors still develop long-term metabolic complications (overweight, obesity, and cardiovascular disease) especially the female gender and patients with an increased body mass index (BMI) at diagnosis. The aim of this review is to describe the state of the art on these topics. We should be able to anticipate, prevent, and treat endocrine long-term morbidities through a well-established follow-up strategy.
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Affiliation(s)
- Patrizia Bruzzi
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Elena Bigi
- b Oncology and Hematology Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Barbara Predieri
- a Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Federico Bonvicini
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Valentina Cenciarelli
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Francesca Felici
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
| | - Lorenzo Iughetti
- c Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia , Modena , Italy
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12
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Coyne CP, Narayanan L. Anti-neoplastic cytotoxicity by complementary simultaneous selective “targeted” delivery for pulmonary adenocarcinoma: fludarabine-(5′-phosphoramidate)-[anti-IGF-1R] in dual-combination with dexamethasone-(C21-phosphoramidate)-[anti-EGFR]. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2018. [DOI: 10.1007/s40005-018-0401-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Kesler SR, Ogg R, Reddick WE, Phillips N, Scoggins M, Glass JO, Cheung YT, Pui CH, Robison LL, Hudson MM, Krull KR. Brain Network Connectivity and Executive Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia. Brain Connect 2018; 8:333-342. [PMID: 29936880 PMCID: PMC6103246 DOI: 10.1089/brain.2017.0574] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chemotherapeutic agents used to treat acute lymphoblastic leukemia (ALL), the most common cancer affecting young children, have been associated with long-term cognitive impairments that reduce quality of life. Executive dysfunction is one of the most consistently observed deficits and can have substantial and pervasive effects on academic success, occupational achievement, psychosocial function, and psychiatric status. We examined the neural mechanisms of executive dysfunction by measuring structural and functional connectomes in 161 long-term survivors of pediatric ALL, age 8-21 years, who were treated on a single contemporary chemotherapy-only protocol for standard/high- or low-risk disease. Lower global efficiency, a measure of information exchange and network integration, of both structural and functional connectomes was found in survivors with executive dysfunction compared with those without dysfunction (p < 0.046). Patients with standard/high- versus low-risk disease and those who received greater number of intrathecal treatments containing methotrexate had the lowest network efficiencies. Patients with executive dysfunction also showed hyperconnectivity in sensorimotor, visual, and auditory-processing regions (p = 0.037) and poor separation between sensorimotor, executive/attention, salience, and default mode networks (p < 0.0001). Connectome disruption was consistent with a pattern of delayed neurodevelopment that may be associated with reduced resilience, adaptability, and flexibility of the brain network. These findings highlight the need for interventions that will prevent or manage cognitive impairment in survivors of pediatric acute lymphoblastic leukemia.
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Affiliation(s)
- Shelli R. Kesler
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert Ogg
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wilburn E. Reddick
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nicholas Phillips
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew Scoggins
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John O. Glass
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yin Ting Cheung
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
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14
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Liu B, Li S, Sui X, Guo L, Liu X, Li H, Gao L, Cai S, Li Y, Wang T, Piao X. Root Extract of Polygonum cuspidatum Siebold & Zucc. Ameliorates DSS-Induced Ulcerative Colitis by Affecting NF-kappaB Signaling Pathway in a Mouse Model via Synergistic Effects of Polydatin, Resveratrol, and Emodin. Front Pharmacol 2018; 9:347. [PMID: 29695964 PMCID: PMC5904535 DOI: 10.3389/fphar.2018.00347] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/26/2018] [Indexed: 01/07/2023] Open
Abstract
Background:Polygonum cuspidatum Siebold & Zucc. (PCS) has antibacterial properties and may prevent Ulcerative colitis (UC) but related molecular mechanism remains unknown. NF-κB signaling pathway is associated with inflammatory responses and its inactivation may be critical for effective therapy of UC. Methods: UC mouse (C57BL/6J) model was established by using dextran sulfate sodium (DSS). The extract of PCS (PCSE) was prepared by using ethanol and its main ingredients were measured by HPLC. Thirty-two UC mice were evenly assigned into DG (received vehicle control), LG (0.1 g/kg PCSE daily), MG (0.2 g/kg PCSE daily) and HG (0.4 g/kg PCSE daily) groups. Meanwhile, 8 healthy mice were assigned as a control group (CG). Serum pharmacokinetics of PCS was measured by using HPLC. After 8-day treatment, weight, colon length and disease activity index (DAI) were measured. Inflammatory cytokines and oxidant biomarkers were measured by ELISA kits. The levels of cytokines, and key molecules in NF-κB pathway, were measured by using Western Blot. The effects of main ingredients of PCSE on cytokines and NF-κB signaling pathway were explored by using intestinal cells of a mouse UC model. The normality criterion was evaluated using the Saphiro–Wilk test. The quantitative variables were compared using the paired Student’s-t test. Results: The main ingredients of PCSE were polydatin, resveratrol and emodin. Polydatin may be transformed into resveratrol in the intestine of the mice. PCSE prevented DSS-caused weight loss and colon length reduction, and improved histopathology of UC mice (P < 0.05). PCSE treatment increased the serum levels of IL-10 and reduced the levels of IL-1 beta, IL-6 and TNF-α (P < 0.05). PCSE increased the activities of SOD, CAT, GPX and reduced the level of MDA, BCL-2, beta-arrestin, NF-κB p65 and the activity of MPO (P < 0.05). The combination of polydatin, resveratrol or emodin, and or PCSE exhibited higher inhibitory activities for cytokines and NF-κB signaling related molecules than any one of the three ingredients with same concentration treatment. Conclusion: Oral administration of PCSE suppressed NF-κB signaling pathway and exerts its anti-colitis effects via synergistic effects of polydatin, resveratrol or emodin.
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Affiliation(s)
- Baohai Liu
- Department of Gastroenterology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Shuangdi Li
- Heart Disease Center, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Xiaodan Sui
- Department of Hepatology, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, China
| | - Lianyi Guo
- Department of Gastroenterology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Xingmei Liu
- Department of Gastroenterology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Hongmei Li
- Department of Gastroenterology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Leming Gao
- The Second Dental Center, School of Stomatology, Peking University, Beijing, China
| | - Shusheng Cai
- Department of Gastroenterology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Yanrong Li
- Department of Gastroenterology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Tingting Wang
- Department of Gastroenterology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Xuehua Piao
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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15
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Pranzatelli MR, Tate ED. Dexamethasone, Intravenous Immunoglobulin, and Rituximab Combination Immunotherapy for Pediatric Opsoclonus-Myoclonus Syndrome. Pediatr Neurol 2017; 73:48-56. [PMID: 28651977 DOI: 10.1016/j.pediatrneurol.2017.04.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although pulse-dose dexamethasone is increasingly favored for treating pediatric opsoclonus-myoclonus syndrome (OMS), and multimodal immunotherapy is associated with improved clinical response, there have been no neuroimmunologic studies of dexamethasone-based multimodal disease-modifying therapy. METHODS In this observational retrospective study, 19 children with OMS (with or without associated neuroblastoma) underwent multibiomarker evaluation for neuroinflammation. Nine children of varying OMS severity, duration, and treatment status were treated empirically with pulse dexamethasone, intravenous immunoglobulin (IVIg), and rituximab combination immunotherapy (DEXIR-CI). Another 10 children on dexamethasone alone or with IVIg at initial evaluation only provided a comparison group. Motor severity (total score) was scored rater-blinded via videotapes using the validated OMS Evaluation Scale. RESULTS DEXIR-CI was associated with a 69% reduction in group total score (P = 0.004) and was clinically well tolerated. Patients given the dexamethasone combination exhibited significantly lowered B cell frequencies in cerebrospinal fluid (-94%) and blood (-76%), normalizing the cerebrospinal fluid B cell percentage. The number of patients with positive inflammatory markers dropped 87% (P = 0.002) as did the number of markers. Cerebrospinal fluid oligoclonal bands were positive in four of nine pretreatment patients but zero of six post-treatment patients. In the comparison group, partial response to dexamethasone alone or with IVIg was associated with multiple positive markers for neuroinflammation despite an average of seven months of treatment. CONCLUSIONS Multimechanistic dexamethasone-based combination immunotherapy increases the therapeutic armamentarium for OMS, providing a viable option for less severely affected individuals. Partial response to dexamethasone with or without IVIg is indicative of ongoing neuroinflammation and should be treated promptly and accordingly.
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Affiliation(s)
- Michael R Pranzatelli
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc, Orlando, Florida.
| | - Elizabeth D Tate
- National Pediatric Myoclonus Center, National Pediatric Neuroinflammation Organization, Inc, Orlando, Florida
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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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Coyne CP, Narayanan L. Dexamethasone-(C21-phosphoramide)-[anti-EGFR]: molecular design, synthetic organic chemistry reactions, and antineoplastic cytotoxic potency against pulmonary adenocarcinoma (A549). Drug Des Devel Ther 2016; 10:2575-97. [PMID: 27574398 PMCID: PMC4990379 DOI: 10.2147/dddt.s102075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Corticosteroids are effective in the management of a variety of disease states, such as several forms of neoplasia (leukemia and lymphoma), autoimmune conditions, and severe inflammatory responses. Molecular strategies that selectively "target" delivery of corticosteroids minimize or prevents large amounts of the pharmaceutical moiety from passively diffusing into normal healthy cell populations residing within tissues and organ systems. MATERIALS AND METHODS The covalent immunopharmaceutical, dexamethasone-(C21-phosphoramide)-[anti-EGFR] was synthesized by reacting dexamethasone-21-monophosphate with a carbodiimide reagent to form a dexamethasone phosphate carbodiimide ester that was subsequently reacted with imidazole to create an amine-reactive dexamethasone-(C21-phosphorylimidazolide) intermediate. Monoclonal anti-EGFR immunoglobulin was combined with the amine-reactive dexamethasone-(C21-phosphorylimidazolide) intermediate, resulting in the synthesis of the covalent immunopharmaceutical, dexamethasone-(C21-phosphoramide)-[anti-EGFR]. Following spectrophotometric analysis and validation of retained epidermal growth factor receptor type 1 (EGFR)-binding avidity by cell-ELISA, the selective anti-neoplasic cytotoxic potency of dexamethasone-(C21-phosphoramide)-[anti-EGFR] was established by MTT-based vitality stain methodology using adherent monolayer populations of human pulmonary adenocarcinoma (A549) known to overexpress the tropic membrane receptors EGFR and insulin-like growth factor receptor type 1. RESULTS The dexamethasone:IgG molar-incorporation-index for dexamethasone-(C21-phosphoramide)-[anti-EGFR] was 6.95:1 following exhaustive serial microfiltration. Cytotoxicity analysis: covalent bonding of dexamethasone to monoclonal anti-EGFR immunoglobulin did not significantly modify the ex vivo antineoplastic cytotoxicity of dexamethasone against pulmonary adenocarcinoma at and between the standardized dexamethasone equivalent concentrations of 10(-9) M and 10(-5) M. Rapid increases in antineoplastic cytotoxicity were observed at and between the dexamethasone equivalent concentrations of 10(-9) M and 10(-7) M where cancer cell death increased from 7.7% to a maximum of 64.9% (92.3%-35.1% residual survival), respectively, which closely paralleled values for "free" noncovalently bound dexamethasone. DISCUSSION Organic chemistry reaction regimens were optimized to develop a multiphase synthesis regimen for dexamethasone-(C21-phosphoramide)-[anti-EGFR]. Attributes of dexamethasone-(C21-phosphoramide)-[anti-EGFR] include a high dexamethasone molar incorporation-index, lack of extraneous chemical group introduction, retained EGFR-binding avidity ("targeted" delivery properties), and potential to enhance long-term pharmaceutical moiety effectiveness.
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Affiliation(s)
| | - Lakshmi Narayanan
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS, USA
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18
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Warris LT, van den Heuvel-Eibrink MM, Aarsen FK, Pluijm SMF, Bierings MB, van den Bos C, Zwaan CM, Thygesen HH, Tissing WJE, Veening MA, Pieters R, van den Akker ELT. Hydrocortisone as an Intervention for Dexamethasone-Induced Adverse Effects in Pediatric Patients With Acute Lymphoblastic Leukemia: Results of a Double-Blind, Randomized Controlled Trial. J Clin Oncol 2016; 34:2287-93. [PMID: 27161966 DOI: 10.1200/jco.2015.66.0761] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Dexamethasone is a key component in the treatment of pediatric acute lymphoblastic leukemia (ALL), but can induce serious adverse effects. Recent studies have led to the hypothesis that neuropsychological adverse effects may be a result of cortisol depletion of the cerebral mineralocorticoid receptors. We examined whether including a physiologic dose of hydrocortisone in dexamethasone treatment can reduce neuropsychologic and metabolic adverse effects in children with ALL. PATIENTS AND METHODS We performed a multicenter, double-blind, randomized controlled trial with a crossover design. Of 116 potentially eligible patients (age 3 to 16 years), 50 were enrolled and were treated with two consecutive courses of dexamethasone in accordance with Dutch Childhood Oncology Group ALL protocols. Patients were randomly assigned to receive either hydrocortisone or placebo in a circadian rhythm (10 mg/m(2)/d) during both dexamethasone courses. Primary outcome measure was parent-reported Strength and Difficulties Questionnaire in Dutch, which assesses psychosocial problems. Other end points included questionnaires, neuropsychological tests, and metabolic parameters. RESULTS Of 48 patients who completed both courses, hydrocortisone had no significant effect on outcome; however, a more detailed analysis revealed that in 16 patients who developed clinically relevant psychosocial adverse effects, addition of hydrocortisone substantially reduced their Strength and Difficulties Questionnaire in Dutch scores in the following domains: total difficulties, emotional symptoms, conduct problems, and impact of difficulties. Moreover, in nine patients who developed clinically relevant, sleep-related difficulties, addition of hydrocortisone reduced total sleeping problems and disorders of initiating and maintaining sleep. In contrast, hydrocortisone had no effect on metabolic parameters. CONCLUSION Our results suggest that adding a physiologic dose of hydrocortisone to dexamethasone treatment can reduce the occurrence of serious neuropsychological adverse effects and sleep-related difficulties in pediatric patients with ALL.
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Affiliation(s)
- Lidewij T Warris
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands.
| | - Marry M van den Heuvel-Eibrink
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Femke K Aarsen
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Saskia M F Pluijm
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Marc B Bierings
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Cor van den Bos
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Christian M Zwaan
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Helene H Thygesen
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim J E Tissing
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Margreet A Veening
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Rob Pieters
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
| | - Erica L T van den Akker
- Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Femke K. Aarsen, Saskia M.F. Pluijm, Christian M. Zwaan, Rob Pieters, and Erica L.T. van den Akker, Erasmus MC-Sophia Children's Hospital, Rotterdam; Cor van den Bos, Academic Medical Center-Emma Children's Hospital; Margreet A. Veening, Vrije Universiteit Medical Center; Helene H. Thygesen, Netherlands Cancer Institute, Amsterdam; Marc B. Bierings, University Medical Center Utrecht-Wilhelmina Children's Hospital; Lidewij T. Warris, Marry M. van den Heuvel-Eibrink, Marc B. Bierings, and Rob Pieters, Princess Máxima Center for Pediatric Oncology, Utrecht; Wim J.E. Tissing, University Medical Center Groningen, Groningen, the Netherlands
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Daniel LC, Li Y, Kloss JD, Reilly AF, Barakat LP. The impact of dexamethasone and prednisone on sleep in children with acute lymphoblastic leukemia. Support Care Cancer 2016; 24:3897-906. [PMID: 27108263 DOI: 10.1007/s00520-016-3234-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Corticosteroids can affect sleep patterns, mood, and behavior. Two of the most commonly prescribed corticosteroids in acute lymphoblastic leukemia (ALL), dexamethasone and prednisone, may impact sleep differently, but no research has compared these medications in children. The current study tested the hypothesis that dexamethasone and prednisone differentially affect sleep in children with ALL to understand how these medications contribute to health-related quality of life (HRQL). METHODS Parents of 81 children 3-12 years old in maintenance therapy for ALL completed a baseline measure of child sleep (dexamethasone n = 55, prednisone n = 26), and 61 parents returned 28 days of child sleep diaries starting the first day of a 5-day steroid course (dexamethasone n = 43, prednisone n = 18). Parents also completed measures of HRQL and fatigue on the last day of steroids and the last day of the month. RESULTS At baseline, parents reported more sleep disturbances in children taking dexamethasone than prednisone. Across the month, children taking dexamethasone experienced poorer sleep quality compared to children taking prednisone. During corticosteroid treatment, children taking dexamethasone also experienced more night awakenings than children taking prednisone. Sleep variables accounted for almost half of the variance in HRQL during time off steroids and also significantly contributed to fatigue during the corticosteroids course and time off corticosteroids. CONCLUSIONS Sleep is an essential component of HRQL in children taking corticosteroids, and the impact on sleep is more pronounced in children taking dexamethasone compared to prednisone. Screening for sleep disturbances and offering brief interventions to manage steroid-related sleep disruptions may improve HRQL.
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Affiliation(s)
- Lauren C Daniel
- Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA.
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anne F Reilly
- Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd., CTRB 10-300, Philadelphia, PA, 19104, USA.,Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Adams M, Robling M, Grainger J, Tomlins J, Johnson A, Morris S, Velangi M, Jenney M. Quality of life Evaluation in patients receiving Steroids (the QuESt tool): initial development in children and young people with acute lymphoblastic leukaemia. Arch Dis Child 2016; 101:241-6. [PMID: 26699534 DOI: 10.1136/archdischild-2015-309139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/25/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND The powerful cytotoxic and immunomodulatory effects of corticosteroids are an important element of the success that has been achieved in the treatment of acute lymphoblastic leukaemia (ALL). In addition to physical side effects, corticosteroids can adversely influence behaviour, cognitive function and mood leading to significantly impaired quality of life (QoL). A number of tools exist for assessing QoL, but none of these specifically examines changes attributable to steroids. METHODS Children and young adults aged 8-24 years and parents of children receiving maintenance therapy for ALL from four UK centres were invited to participate. The study comprised three stages carried out over 2 years: (1) focus groups and interviews where participants were asked to describe their experiences of dexamethasone; (2) analysis of questionnaires sent to healthcare professionals and patients to evaluate the importance and relevance of the questions; and (3) cognitive interviewing. RESULTS Interpretative phenomenological analysis of focus group and interview transcripts identified that dexamethasone adversely influenced behaviour, appetite, body image, mood and family relationships. 157 electronic survey responses were analysed leading to further item development. Cognitive interviewing confirmed face validity and internal consistency. QuESt comprises 28 questions within four domains and has three age-specific versions. CONCLUSIONS QuESt is the first treatment-specific QoL measure for children and young adults receiving corticosteroids. It can be completed in 10-15 min by children aged ≥8 years. Further validity and reliability testing will be undertaken. Although the initial application is for ALL, QuESt may also be a valuable tool for understanding the impact of corticosteroids in other paediatric conditions.
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Affiliation(s)
- M Adams
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - M Robling
- Institute of Primary Care and Public Health, Cardiff University , Cardiff, UK
| | - J Grainger
- Department of Paediatric Haematology, Royal Manchester Children's Hospital, Manchester, UK
| | - J Tomlins
- Teenage and Young Adult Haematology Department, Christie Hospital, Manchester, UK
| | - A Johnson
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - S Morris
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
| | - M Velangi
- Department of Paediatric Haematology, Birmingham Children's Hospital, Birmingham, UK
| | - M Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Cardiff, UK
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Cheung YT, Krull KR. Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review. Neurosci Biobehav Rev 2015; 53:108-20. [PMID: 25857254 PMCID: PMC4425605 DOI: 10.1016/j.neubiorev.2015.03.016] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/06/2015] [Accepted: 03/13/2015] [Indexed: 01/13/2023]
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.
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Affiliation(s)
- Yin Ting Cheung
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA.
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