Abstract
10033 Background: Intrathecal medications have replaced cranial radiation for central nervous system (CNS) prophylaxis in most patients with ALL. The relative long-term toxicities of different intrathecal preparations are uncertain. The objective of this study is to compare neurobehavioral outcomes of children with ALL randomized on a legacy Children’s Oncology Group study to either intrathecal methotrexate (MTX) or methotrexate/hydrocortisone/cytarabine (ITT). Methods: Cross-sectional study at 32 sites. The neurobehavioral evaluation included: Wechsler Intelligence Scale for Children-IV (WISC-IV), Wechsler Individual Achievement Test-2nd Ed. Abbrev. (WIAT-II-A), Behavior Rating Inventory of Executive Function (BRIEF), FAS Fluency (FAS), and the Beery Developmental Test of Visual Motor Integration (VMI). Results: Data were received on 147 patients (46% F); 46% received MTX and 54% ITT. Mean age = 11.9 years, age at diagnosis = 4.3 years, and interval since diagnosis = 7.6 years. The groups were similar in age, gender, and time since diagnosis. Mean Full Scale IQ was similar in both groups (99.1±11.4 vs 99.7± 13.3). WIAT-II-A scores were average in word reading, mathematics, and spelling for both subgroups, as were mean BRIEF and FAS scores for executive function. The MTX group had a lower mean score on the Processing Speed Index (93.8±10.9 vs 97.2±10.7, p=0.07); 18% in the MTX group scored >1 standard deviation (SD) below the normative mean compared with 7% of the ITT group (p=0.04). Mean scores on Beery VMI were significantly lower than the normative mean of 100. (91.3±13.6 for MTX group, p<0.0001 and 94.5±13.2 for ITT group, p=0.0007), but did not differ by treatment subgroup. Conclusions: Patients treated with ITT had neurobehavioral functioning similar to those who received MTX alone, except for mildly reduced processing speed in MTX patients. Both groups of patients performed in the average range except for a relative weakness in visual motor integration. No significant financial relationships to disclose.
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