Cancer Research, Statistics, and Treatment

: 2021  |  Volume : 4  |  Issue : 2  |  Page : 410--411

Authors' reply to Bagal et al. and Bansal

Jisha Abraham1, Venkatraman Radhakrishnan2, Surendran Veeraiah1,  
1 Department of Psycho-Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
2 Department of Medical Oncology and Pediatric Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

Correspondence Address:
Surendran Veeraiah
Department of Psycho-Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu

How to cite this article:
Abraham J, Radhakrishnan V, Veeraiah S. Authors' reply to Bagal et al. and Bansal.Cancer Res Stat Treat 2021;4:410-411

How to cite this URL:
Abraham J, Radhakrishnan V, Veeraiah S. Authors' reply to Bagal et al. and Bansal. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Sep 17 ];4:410-411
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Full Text

We thank Bagal et al. for their comments on our article titled, “Neuropsychological functioning in long-term survivors of pediatric acute lymphoblastic leukemia: A prospective cross-sectional study.”[1],[2] We agree with Bagal et al. that neuropsychological dysfunction in patients with acute lymphoblastic leukemia (ALL) is multifactorial. Over the past few years, treatment protocols have evolved for ALL, including at our center.[3] Since 2014, we have adopted the Indian Childhood Leukemia (ICICLE) protocol. The ICICLE protocol does not use prophylactic cranial radiotherapy.[4] In our study, we did not assess the neuropsychological functioning of patients treated with the ICICLE protocol. The current pediatric ALL protocols, including the ICICLE, are risk-stratified and use high-dose methotrexate (HDMTX) only for T-cell ALL or high-risk B-cell ALL and therapeutic cranial radiotherapy for patients with central nervous system-positive disease. Our center has reported the neuropsychological outcomes of patients treated with HDMTX and cranial radiotherapy.[5] A prospective study to assess the neuropsychological functioning in patients treated with the ICICLE protocol would delineate the impact of risk stratification, especially the use of HDMTX.

We agree with Bansal that our study is limited by its small sample size and the lack of a control group.[6] We did not calculate the verbal or performance intelligence quotient and academic performance as the objective was to find specific functions, contributing to the individual's intellectual, academic, occupational, or holistic functioning. Further, we reported discrepancies in the visuoconstructive and visuomotor abilities between adult and adolescent survivors in our study. Even though the literature on neuropsychological functioning in children with ALL reports contradictory findings, our results are not surprising, as these differences in findings can be attributed to the heterogeneity in the studies, with regard to the patient age, treatment protocols used, method of assessment, and timing of assessment.[7] There is also the possibility of biological and cultural factors influencing the neuropsychological outcomes in children with ALL.

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Conflicts of interest

There are no conflicts of interest.


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2Abraham 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.
3Malard F, Mohty M. Acute lymphoblastic leukaemia. Lancet 2020;395:1146-62.
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