Abstract
IntroductionThe aim of this study was to assess the long-term side effects of central nervous system prophylaxis (high-dose chemotherapy alone vs chemotherapy and CNS radiotherapy) according to the ALL IC-BFM 2002.MethodsThirty-tree children aged 6.7–19.9 years have been studied. The control group consisted of 12 children newly diagnosed with acute lymphoblastic leukemia. We assessed subcortical gray matter volume using automatic MRI segmentation and cognitive performance to identify differences between two therapeutic schemes and patients prior to treatment.ResultsPatients treated with chemotherapy and CNS radiotherapy had smaller hippocampi than two other subgroups and lower IQ score than patients treated with chemotherapy alone. Both treated groups, whether with chemotherapy only or in combination with CNS radiotherapy, had significantly lower volumes of caudate nucleus and performed significantly worse on measures of verbal fluency in comparison with patients prior to treatment. There were no differences in the mean volumes of total white matter, total gray matter, thalamus, putamen, and amygdala between the studied groups.ConclusionIn all children treated according to the ALL IC-BFM 2002 with high-dose chemotherapy, both decreased volume of selected subcortical structures and cognitive impairment was observed, especially in children who received chemotherapy in combination with reduced dose CNS radiotherapy. In all children treated according to the ALL IC-BFM 2002 with high-dose chemotherapy, both decreased volume of selected subcortical structures and cognitive impairment were observed, especially in children who received chemotherapy in combination with CNS radiotherapy.
Highlights
The aim of this study was to assess the long-term side effects of central nervous system prophylaxis according to the Acute lymphoblastic leukemia (ALL) IC-BFM 2002
Treatment of ALL in children based on the ALL IC-BFM 2002 protocol (ALLIC 2002) is composed of multi-drug chemotherapy adjusted for three risk subgroups administered repeatedly for 24 months and central nervous system (CNS) radiotherapy given to a particular group of patients
Neuroradiology (2017) 59:147–156 depending on risk group and immunophenotype of leukemia—consists of systemic chemotherapy with intravenous methotrexate in high or medium doses, intrathecal methotrexate alone, or in combination with cytarabine and prednisone and CNS radiotherapy at total dose of 12 Gy which is used only in patients stratified into high-risk group and T-cell ALL
Summary
The aim of this study was to assess the long-term side effects of central nervous system prophylaxis (high-dose chemotherapy alone vs chemotherapy and CNS radiotherapy) according to the ALL IC-BFM 2002. We assessed subcortical gray matter volume using automatic MRI segmentation and cognitive performance to identify differences between two therapeutic schemes and patients prior to treatment. Treatment of ALL in children based on the ALL IC-BFM 2002 protocol (ALLIC 2002) is composed of multi-drug chemotherapy adjusted for three risk subgroups (standard, intermediate, and high) administered repeatedly for 24 months and central nervous system (CNS) radiotherapy given to a particular group of patients. There is very limited evidence regarding impact of the therapy on gray matter (GM) structures and its relationship to cognitive performance in ALL survivors
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