|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 408-409
Cancer-related cognitive impairment in survivors of acute lymphoblastic leukemia
Bhausaheb Bagal1, Dipalee Borade2, George John1
1 Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
2 Department of Radiation Oncology, Apollo Hospital, Mumbai, Maharashtra, India
|Date of Submission||14-Apr-2021|
|Date of Decision||16-Apr-2021|
|Date of Acceptance||18-Apr-2021|
|Date of Web Publication||30-Jun-2021|
Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|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
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.
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. 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.,,
Abraham et al. have reported on the neuropsychological outcomes in survivors of childhood ALL., 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.
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Conflicts of interest
There are no conflicts of interest.
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