For children with acute lymphocytic leukemia (ALL), F2-isoprotane (F2-ISoP) concentrations in cerebrospinal fluid (CSF) may be a viable marker for cognitive dysfunction, according to results of study published in Oncology Nursing Forum.

Patients with ALL receive central nervous system-directed chemotherapy, which crosses the blood-brain barrier. Some of these therapies have been associated with cognitive dysfunction and neuroanatomical white matter changes in pediatric patients. Which biomarkers may be effective tools for monitoring cognitive effects of maintenance therapy remains unclear.

Data for this study were sourced from a group of 30 children and adolescents with ALL participating in a larger trial conducted at Children’s Minnesota and Texas Children’s Hospital. This cohort was repeatedly assessed for a set of CSF biomarkers and cognitive measurements. Biomarkers and cognitive functioning at the beginning of maintenance (BOM) therapy were compared with those at end of maintenance (EOM) therapy. Maintenance therapy was administered in 12-week cycles ending approximately 1.75 years after baseline.

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Patients were an average age of 7.6±4 years at diagnosis; they began maintenance therapy at age 8.6±4 years, and finished therapy at age 10.3±4.1 years.

Between the BOM and EOM therapy, interleukin (IL)-8 (t, 4.43; P <.01) and Parent-Perceived Child Cognitive Function (PedsPCF) scores (t, -2.51; P =.02) changed significantly, whereas F2-ISoP (t, 1.77; P =.09) did not.

At the EOM therapy, higher F2-ISoP levels associated with lower Flanker scores (P <.05). Stratified by normal (12 children) and lower (14 children) cognitive function, F2-ISoP levels at the beginning (t, 3.44; P <.01) and end (t, 2.51; P =.02) of therapy differed significantly between cohorts.

This study was limited as the researchers had difficulty recruiting participants, particularly older children and adolescents.

These data indicated that F2-ISoP levels at BOM and EOM therapy among pediatric patients with ALL may be an effective biomarker for cognitive outcomes. The researchers suggest confirming these findings with a larger, independent cohort.


Hooke MC, Mathiason MA, Kunin-Batson AS, et al. Biomarkers and cognitive function in children and adolescents during maintenance therapy for leukemia. Oncol Nurs Forum. 2021;48(6):623-633. doi: 10.1188/21.ONF.623-633