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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 408-409

Cancer-related cognitive impairment in survivors of acute lymphoblastic leukemia


1 Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
2 Department of Radiation Oncology, Apollo Hospital, Mumbai, Maharashtra, India

Date of Submission14-Apr-2021
Date of Decision16-Apr-2021
Date of Acceptance18-Apr-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Bhausaheb Bagal
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_76_21

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How to cite this article:
Bagal B, Borade D, John G. Cancer-related cognitive impairment in survivors of acute lymphoblastic leukemia. Cancer Res Stat Treat 2021;4:408-9

How to cite this URL:
Bagal B, Borade D, John G. Cancer-related cognitive impairment in survivors of acute lymphoblastic leukemia. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Sep 25];4:408-9. Available from: https://www.crstonline.com/text.asp?2021/4/2/408/320249



Cancer-related cognitive impairment (CRCI) is being increasingly recognized as a long-term complication. Various risk factors for CRCI have been described, including age, gender, cognitive reserve, genetic risk factors, and specific treatments (chemotherapy penetrating the blood–brain barrier like high-dose methotrexate [HD-MTX] and 5-fluorouracil, radiation-related variables like total dose, per fraction dose, and areas irradiated for radiation therapy). The pathogenesis appears to be multifactorial and remains to be elucidated in detail. The proposed main mechanism of damage includes impaired hippocampal neuronal generation, white matter damage, oxidative damage, vascular damage with impaired blood flow in the microcirculation, and impaired hypothalamic–pituitary–adrenal axis.[1]

Childhood acute lymphoblastic leukemia (ALL) is an important disease from the perspective of CRCI because of the high cure rates, younger age at presentation, and the use of specific therapies with a high risk of CRCI, like prophylactic cranial irradiation (PCI) and HD-MTX-based central nervous system (CNS) prophylaxis.[2] With intensive systemic therapies such as HD-MTX and cytarabine and the ability to salvage the CNS relapses, PCI is being increasingly avoided for the treatment of childhood ALL, however, it continues to be used where an intensive pediatric inspired protocol and/or salvage of CNS relapse is not feasible.[3],[4],[5]

Abraham et al. have reported on the neuropsychological outcomes in survivors of childhood ALL.[6],[7] We would like to congratulate the authors for taking up this often-neglected work amid the busy clinical practice of a high-volume center like theirs. In a cohort of 51 patients, it was observed that adult survivors had deficits in immediate memory, visuoconstructive ability, verbal learning, immediate recall, and visuomotor speed, whereas adolescent survivors had deficits in immediate memory and verbal working memory. These findings are in line with those reported in the literature. In this cohort of patients receiving PCI, because of the change in the protocol used over time, not all patients received HD-MTX-based systemic treatment. This provides an opportunity to look at the effect of HD-MTX on neuropsychological functioning, and we request the authors to comment on the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hardy SJ, Krull KR, Wefel JS, Janelsins M. Cognitive changes in cancer survivors. Am Soc Clin Oncol Educ Book 2018;38:795-806.  Back to cited text no. 1
    
2.
Hunger SP, Mullighan CG. Acute lymphoblastic leukemia in children. N Engl J Med 2015;373:1541-52.  Back to cited text no. 2
    
3.
Ganesan P, Jain H, Bagal B, Subramanian PG, George B, Korula A, et al. Outcomes in adolescent and young adult acute lymphoblastic leukaemia: A report from the Indian Acute Leukaemia Research Database (INwARD) of the Hematology Cancer Consortium (HCC). Br J Haematol 2021;193:e1-4.  Back to cited text no. 3
    
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Radhakrishnan VS, Agrawal N, Bagal B, Patel I. Systematic review of the burden and treatment patterns of adult and adolescent acute lymphoblastic leukemia in India: Comprehending the challenges in an emerging economy. Clin Lymphoma Myeloma Leuk 2021;21:e85-98.  Back to cited text no. 4
    
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Pandey A, Ahlawat S, Singh A, Singh S, Murari K, Aryan R. Outcomes and impact of minimal residual disease (MRD) in pediatric, adolescent and young adults (AYA) with acute lymphoblastic leukemia treated with modified MCP 841 protocol. Cancer Res Stat Treat 2020;3:183-91.  Back to cited text no. 5
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6.
Abraham J, Veeraiah S, Radhakrishnan V. Neuropsychological functioning in long-term survivors of pediatric acute lymphoblastic leukemia: A prospective cross-sectional study. Cancer Res Stat Treat 2021;4:19-28.  Back to cited text no. 6
  [Full text]  
7.
Datta SS, Mukherjee A. “My cancer is cured, but I do not feel normal”: A commentary on neuropsychological outcomes of pediatric acute lymphocytic leukemia in India. Cancer Res Stat Treat 2021;4:119-20.  Back to cited text no. 7
  [Full text]  




 

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