Long-term Attention and Learning Deficits Persist After Chemotherapy for Pediatric Leukemia

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Pediatric survivors of acute lymphoblastic leukemia (ALL) treated only with chemotherapy remain at an increased risk for attention problems 2 years after treatment cessation, according to a new study. ALL is the most common pediatric cancer and is highly treatable.1

Intensive chemotherapy alone without cranial radiation therapy is a contemporary approach. It aims to reduce the neurocognitive deficits associated with cranial radiation therapy. Neurocognitive deficits, while ameliorated with chemotherapy treatment alone, continue to affect ALL survivors.

This study, published in the Journal of Clinical Oncology, examined longitudinal neurocognitive assessments of patients enrolled in the St. Jude Total Therapy Study XV. These patients received only intensive chemotherapy for the treatment of ALL.

Researchers completed comprehensive neuropsychological assessments at induction (142 patients), end of maintenance (243 patients), and 2 years after completion of therapy (211 patients). Although neurocognitive function was largely age-appropriate 2 years after completion of chemotherapy, significant attention deficits and learning problems existed, compared with national normative data.

“These findings provide additional evidence that neurocognitive functioning has improved in survivors of childhood ALL since cranial irradiation was replaced with intensified chemotherapy,” said Lisa Jacola, PhD, research associate at St. Jude Children's Research Hospital Department of Psychology, Memphis, Tennessee, and first author of the study.

“But we also show these young people are at an elevated risk for attention problems that have real-world consequences, particularly for learning and school performance.”

Attentional deficits at the cessation of chemotherapy were predictive of worse academic performance 2 years later. Gender of the patient and age at diagnosis both may affect neurocognitive development in survivors of ALL treated with chemotherapy only.

“Attention is a building block for learning, and in this study attention difficulties predicted academic problems later. If we know attention problems seen at the end of therapy continue and contribute to academic problems, then our goal is to intervene earlier to reduce or prevent such difficulties,” stated Jacola.

This research was funded in part by grants from the National Cancer Institute at the National Institutes of Health, and ALSAC (St. Jude Children's Research Hospital).


1. Jacola LM, Krull KR, Pui CH, et al. Longitudinal assessment of neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia treated on a contemporary chemotherapy protocol [published online ahead of print February 8, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.64.3205.

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