TITLE PAGE: NEUROCOGNTIVE OUTCOMES IN SURVIVORS OF CHILDHOOD ACUTE
LYMPHOBLASTIC LEUKEMIA: EXPERIENCE FROM A TERITARY CARE CENTRE IN INDIA
Abstract
BACKGROUND: Neurocognitive deficits are an important late effect in
survivors of acute lymphoblastic Leukemia(ALL). Data from low middle
income countries is scarce and highly influenced by biological and
cultural variations. Such data would be useful for highlighting the
importance of early intervention in an already disadvantaged population.
PROCEDURE: 70 consecutive survivors of childhood ALL were evaluated for
neurocognitive deficits by the Indian adaptation of Wechsler
Intelligence Scale for Children-Fourth Edition(WISC-INDIA). Prevalence
of neurocognitive deficits was calculated based on Full Scale
Intelligence Quotient(FSIQ) and scores in discrete domains like Verbal
Comprehension, Perceptual Reasoning, Working Memory and Processing Speed
were calculated and compared to baseline characteristics, chemotherapy
and radiation dose received. RESULTS: The mean FSIQ was 86.1 ± 20.5,
with significant neurocognitive deficit(FSIQ <90) being
prevalent in 50%(95% CI 38% to 62%) of the cohort. The proportion of
survivors with deficits in individual domains of verbal comprehension,
perceptual reasoning, working memory and processing speed were 49%,
50%, 47% and 44% respectively. The odds of having deficits in
neurocognitive function was higher when a child belonged to lower
socioeconomic strata, had parents with less than primary school
education and whose birth order was higher(All p<0.05). Age at
diagnosis, current age at assessment, receiving lower or higher dose of
radiotherapy, high dose methotrexate or cytarabine did not have a direct
impact on neurocognitive function. CONCLUSIONS AND RELEVANCE: The
current need is to develop country specific neurocognition assessment
tools to initiate early screening and develop culturally appropriate
preventive and rehabilitative interventions.