42498
document
Comparison of neurocognitive functioning in children previously randomly assigned to intrathecal methotrexate compared with triple intrathecal therapy for the treatment of childhood acute lymphoblastic leukemia . PURPOSE For the majority of children with acute lymphoblastic leukemia ( ALL ) , CNS prophylaxis consists of either intrathecal ( IT ) methotrexate or triple IT therapy ( ie , methotrexate with both cytarabine and hydrocortisone ) . The long-term neurotoxicities of these two IT strategies have not yet been directly compared . PATIENTS AND METHODS In this multisite study , 171 children with standard-risk ALL , age 1 to 9.99 years at diagnosis , previously randomly assigned to IT methotrexate ( n = 82 ) or to triple IT therapy ( n = 89 ) on CCG 1952 , underwent neurocognitive evaluation by a licensed psychologist at a mean of 5.9 years after random assignment . RESULTS Patients who received IT methotrexate had a mean Processing Speed Index that was 3.6 points lower , about one fourth of a standard deviation , than those who received triple IT therapy ( P = .04 ) after analysis was adjusted for age , sex , and time since diagnosis . Likewise , 19.5 % of children in the IT methotrexate group had a Processing Speed Index score in the below-average range compared with 6.9 % in the triple IT therapy group ( P = .02 ) . Otherwise , the groups performed similarly on tests of full-scale intelligence quotient , academic achievement , attention/concentration , memory , and visual motor integration . The association of treatment with measures of cognitive functioning was not modified by sex or age at diagnosis . In the post-therapy period , there were no group differences in special education services , neurologic events , or use of psychotropic medications . CONCLUSION This study did not show any clinically meaningful differences in neurocognitive functioning between patients previously randomly assigned to IT methotrexate or triple IT therapy except for a small difference in processing speed in the IT methotrexate group .
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Intervention_Pharmacological
intrathecal methotrexate
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Intervention_Pharmacological
triple intrathecal therapy
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Intervention_Pharmacological
intrathecal ( IT ) methotrexate
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Intervention_Pharmacological
triple IT therapy ( ie , methotrexate with both cytarabine and hydrocortisone
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Intervention_Pharmacological
IT methotrexate
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Intervention_Pharmacological
triple IT therapy
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Intervention_Pharmacological
IT methotrexate
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Intervention_Pharmacological
triple IT therapy
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Intervention_Pharmacological
IT methotrexate
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Intervention_Pharmacological
triple IT therapy group
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Intervention_Pharmacological
IT methotrexate
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Intervention_Pharmacological
triple IT therapy
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Intervention_Pharmacological
IT methotrexate group .
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Outcome_Other
neurocognitive functioning
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Outcome_Mental
mean Processing Speed Index
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Outcome_Mental
Processing Speed Index score
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Outcome_Mental
tests of full-scale intelligence quotient
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Outcome_Mental
academic achievement
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Outcome_Mental
attention/concentration
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Outcome_Mental
memory
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Outcome_Mental
visual motor integration
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Outcome_Mental
measures of cognitive functioning
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Outcome_Mental
special education services
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Outcome_Mental
neurologic events
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Outcome_Mental
use of psychotropic medications
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Outcome_Mental
neurocognitive functioning
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Outcome_Mental
processing speed
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Participant_Condition
lymphoblastic leukemia
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Participant_Age
children
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Participant_Condition
acute lymphoblastic leukemia ( ALL )
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Participant_Sample-size
171
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Participant_Age
children
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Participant_Age
age 1 to 9.99 years