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Abstract:
Introduction: Central nervous system (CNS) treatment for
acute lymphoblastic leukaemia (ALL) can result in
neuropsychological sequelae, under achievement, and behavioural
difficulties in some children. Aim: To examine the consequences on
cognition and behaviour of different types of ALL therapy.
Patients: Four groups of patients (N = 558), aged 2 to 16 years at
diagnosis, and a control group (N = 332) participated. Patients
were grouped on the basis of white cell count (WCC) at diagnosis
and the treatment received according to the UKALL XI protocols.
Methods: Neuropsychological evaluations were conducted at 5 months,
3 years and 5 years post diagnosis for each child. Assessment
included measures of intelligence, memory and learning, language,
executive function, academic attainments, visuoperceptual skills,
and motor function. Results: Overall cognitive outcome was
significantly affected by treatment type in the high WCC group
(> 50 x 109/l) with the cranial irradiation group being
impaired. There was no main effect for treatment type in the low
WCC group (< 50 x 109/l). Age at diagnosis was an important
influence on cognitive outcome in all groups. Conclusion: Children
receiving treatment for ALL should have their cognitive development
carefully monitored to ensure adequate monitoring of educational
and social needs.
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