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Comparison of neurocognitive functioning in children previously randomly assigned to intrathecal methotrexate compared with triple intrathecal therapy for the treatment of childhood acute lymphoblastic leukemia
Journal of Clinical Oncology, 11/09/09

Kadan-Lottick NS et al. – This study did not show any clinically meaningful differences in neurocognitive functioning between patients previously randomly assigned to IT methotrexate or triple IT therapy except for a small difference in processing speed in the IT methotrexate group.

Methods

Multisite study
171 children with standard-risk ALL
Age 1 to 9.99 years at diagnosis
Previously randomly assigned to IT methotrexate (n = 82) or to triple IT therapy (n = 89) on CCG 1952
Neurocognitive evaluation by licensed psychologist at mean of 5.9 years after random assignment

Results

Patients who received IT methotrexate had mean Processing Speed Index 3.6 points lower, about 1/4 standard deviation, than those who received triple IT therapy after analysis adjusted for age, sex, and time since diagnosis
19.5% of children in IT methotrexate group had Processing Speed Index score in below-average range compared with 6.9% in triple IT therapy group
Otherwise, groups performed similarly on tests of full-scale intelligence quotient, academic achievement, attention/concentration, memory, and visual motor integration
Association of treatment with measures of cognitive functioning not modified by sex or age at diagnosis
In post-therapy period, no group differences in special education services, neurologic events, or use of psychotropic medications

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