MEMORY FUNCTION OF CHILDREN WITH ACUTE LYMPHOCYTIC LEUKEMIA (ALL) WHO RECEIVED CNS PROPHYLAXIS (Px) WITH OR WITHOUT 18 Gy CRANIAL IRRADIATION (CrRT)

Abstract

The potentially adverse effects of CNS Px upon neuropsychological function in survivors of ALL is of concern. Forty patients (pts) (mean age 10.6 yrs) with normal IQ's. with ALL, and no evidence of CNS disease at diagnosis were treated on Total X protocol (Proc. ASCO 5:632, 1986) in which they were randomized to receive intrathecal methotrexate (IT) alone or with 18 Gy CrRT as CNS Px. Pts receiving only IT also had pulses of high dose MTX (1 gm/m2) (HDMTX). All children remained in complete, continuous remission 3+ yrs after completing therapy (5 1/2+ yrs post diagnosis) and were entered on this study of memory function on an unselected basis until 2C evaluable cases in each group (IT alone or CrRT & IT) out of a total of 52 eligible pts were enrolled. On 25 memory and behavioral measures, no differences were detected between treatment groups and no agerelated trends were noted. However, short-term (p<.01) and long-term (p<.001) verbal recall and visual-perceptual memory (p<.01) were lower for both groups than the general population. In summary. 18 Gy CrRT+IT does not appear to Increase the neuropsychological deficits of children treated for ALL compared to similar children treated with IT and HDMTX; however, either method of CNS Px often affects selected areas of memory function. The ultimate Impact of these findings on learning is unknown at this time and deserves further study.