Assessment of neuropsychiatric late effects among survivors of childhood leukemia

Objectives: Leukemia is the most common malignancy affecting children. The cure rate has improved with advances in the treatment of acute leukemia, and this increased survival. There is a large number of children surviving leukemia, therefore monitoring the late effects become more important. Many studies have demonstrated late effects. Growth failure, obesity, cardiac toxicity, endocrinological and gastrointestinal diseases, pulmonary complications, pubertal disorders, infertility, osteopenia, osteoporosis, neurocognitive dysfunctions, neurological, visual and auditory disorders and second neoplasms are the most reported late effects. The neurocognitive dysfunctions that are caused by acute leukemia treatment may affect health and life quality of the survivors of childhood leukemia. The objective o this study is to identify the neurophyschiatric late effects of treatment and provide an assesment about the degree and incidence of these late effects and give therapy if needed.Patients and Methods: This study was performed with patients treated between 1993-2009, in Dokuz Eylül University Hospital Department of Pediatric Hematology who had been diagnosed as acute leukemia at least five years ago. All of the patients were treated with BFM protocols and none of them relapsed. Demographic features, signs of neurologic and eye examination were evaluated. Cranial MR imaging, hearing tests and neurocognitive tests were performed and the results are noted. The control group for neurocognitive tests were consisted of brother or sister of the patient who has the closest age to the patient. Quality of life questionnarie were filled by patients or parents. In the statistical analysis of data, SPSS (The Statistical Package for Social Sciences) 15.0 packet program was used. Chi Square test, Mann Whitney U test and Pearson correlation test was used as statistical method. The p values less than 0.05 was considered significant.Results: In our study there were 44 patients whom were 8-31 years old (mean age 16.4±6.4 years). Of 44 acute leukemia survivors, 21 (%47.7) were females and 23 (%52.3) were males. Five (%11.4) og the patients was diagnosed as AML and 39 (%88.6)of them was diagnosed as ALL. Patients that had been off therapy for 2-18 years (mean 7.5±4.4 years), were diagnosed at least 5 years ago. One or more late effects detected by examination, neurologic tests and neurocognitive tests occured in 32 (%80) patients, and 28 (%63.6) patients specified at least one complaint in the quality of life questionnaire. Abnormalities was found in four (%9.1) patients by eye examination and four (%9.1) by hearing tests. MR imagings revealed pathological findings in eight (%18.2) patients and there were abnormality of EEG in four (%9.1) patients. When total intelligence scores of 44 patients were evaluated, it was seen that 13(%29.5) patients? IQ scores were less than 80 and 28 (%70) patients? scores demonstrated neurocognitive dysfunctions. When the patients and control group were compared, there was no statistical significant difference in neurocognitive test results. Acoording to the questionnaire?s data the most frequent complaint was headache in 19 (%43) patients. The most common problem in school was denoted by 5 (%11.4) patients as diffuculties in concentration.Conclusion: In our study at least one neuropyschiatric late effect occured in most of the cases. It was statistically significant that the patients who had central nervous system involment at the time of diagnosis had more finding on neurologic examination and tests. Based on the BFM protocol risk criterias the patients in the high risk group at the time of the diagnosis had higher incidence of cataract. Tha patients who are older than 18 during the study, or younger than 6 at the time of diagnosis, or had AML, or had taken high dose (18 Gy) RT were have lower IQ scores. Also neurocognitive disorders more detected in the patients who were older than 18 at the time of study. This situation has been thought that neuropyschicological disorders occur more in older ages. Therapeutic exposures including radiotherapy or chemotherapy will place some acute leukemia survivors at a risk of development of neurological and neurocognitive late effects, because of this long term follow up of childhood acute leukemia survivors is essential.