Long‐term leukoencephalopathy and neurocognitive functioning in childhood sarcoma patients treated with high‐dose intravenous chemotherapy
Purpose Knowledge is limited regarding the prevalence and persistence of chemotherapy‐induced leukoencephalopathy in childhood sarcoma patients. This study explored the presence, clinical relevance, and potential risk factors of leukoencephalopathy in childhood bone and soft tissue sarcoma survivors...
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| Veröffentlicht in: | Pediatric blood & cancer 2019-10, Vol.66 (10), p.e27893-n/a |
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| creator | Sleurs, Charlotte Lemiere, Jurgen Radwan, Ahmed Verly, Marjolein Elens, Iris Renard, Marleen Jacobs, Sandra Sunaert, Stefan Deprez, Sabine Uyttebroeck, Anne |
| description | Purpose
Knowledge is limited regarding the prevalence and persistence of chemotherapy‐induced leukoencephalopathy in childhood sarcoma patients. This study explored the presence, clinical relevance, and potential risk factors of leukoencephalopathy in childhood bone and soft tissue sarcoma survivors, treated with intravenous chemotherapy.
Methods
We acquired cross‐sectional neurocognitive data in adult survivors (n = 34) (median age at diagnosis [AaD] = 13.32 years, age range = 16‐35 years) and healthy age‐matched controls (n = 34). Additionally, magnetic resonance imaging included T2‐weighted FLAIR (leukoencephalopathy Fazekas rating), multiexponential T2 relaxation (MET2), and multishell diffusion MRI to estimate myelin integrity‐related metrics and fluid movement restrictions. Finally, chemotherapy subgroups (methotrexate, alkylating agents, or combination), AaD, and Apoε and MTHFRC677T polymorphisms were explored as potential risk factors for leukoencephalopathy.
Results
At the group level, quality of life, working memory, processing speed, and visual memory were significantly lower in patients compared to controls. Furthermore, long‐term leukoencephalopathy was observed in 27.2% of the childhood sarcoma survivors, which was related to attentional processing speed. Lesions were related to diffusion‐derived, but not to myelin‐sensitive metrics. A significant interaction effect between AaD and chemotherapy group demonstrated more lesions in case of high‐dose methotrexate (HD‐MTX) (F = 3.434, P = .047). However, patients treated with alkylating agents (without HD‐MTX) also showed lesions in younger patients. Genetic predictors were nonsignificant.
Conclusion and implication
This study suggests long‐term leukoencephalopathy with possibly underlying changes in vasculature, inflammation, or axonal injury, but not necessarily long‐term demyelination. Such lesions could affect processing speed, and as such long‐term daily life functioning of these patients. |
| doi_str_mv | 10.1002/pbc.27893 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2253300742</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2253300742</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3533-960bdd068461097aebca377fffd4e7d5175e1dd492be216b07d4eca82e7d41763</originalsourceid><addsrcrecordid>eNp1kc9O3DAQxq0KVOi2B16gssSFHhb8J4mTY1lRirQSHNpz5NiTjSGxU9tZtDeeAPUZ-yQYduFQidOMZn7fNyN9CB1RckoJYWdjo06ZKCv-AR3SPMvnOaFi760n1QH6FMJtQguSlx_RAadMFKwSh-hx6ezq38PfCH7APUx3DqyCsZO9G2XsNlhajS1M3im3siaaNeB2sioaZ41dYWOx6kyvO-c0DtIrN0iclAZsDDh6kBE0vjexw51ZdemSdgGSLHq5BuumkPQwuNiBl-PmM9pvZR_gy67O0O8fF78WP-fL68urxfflXPGc83lVkEZrUpRZQUklJDRKciHattUZCJ1TkQPVOqtYA4wWDRFprmTJ0jKjouAzdLL1Hb37M0GI9WCCgr6XFtJPNWPpDCEiYwk9_g-9dZO36btEiZJwTss8Ud-2lPIuBA9tPXozSL-pKamfQ6pTSPVLSIn9unOcmgH0G_maSgLOtsC96WHzvlN9c77YWj4BkMmhOw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2278033185</pqid></control><display><type>article</type><title>Long‐term leukoencephalopathy and neurocognitive functioning in childhood sarcoma patients treated with high‐dose intravenous chemotherapy</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Sleurs, Charlotte ; Lemiere, Jurgen ; Radwan, Ahmed ; Verly, Marjolein ; Elens, Iris ; Renard, Marleen ; Jacobs, Sandra ; Sunaert, Stefan ; Deprez, Sabine ; Uyttebroeck, Anne</creator><creatorcontrib>Sleurs, Charlotte ; Lemiere, Jurgen ; Radwan, Ahmed ; Verly, Marjolein ; Elens, Iris ; Renard, Marleen ; Jacobs, Sandra ; Sunaert, Stefan ; Deprez, Sabine ; Uyttebroeck, Anne</creatorcontrib><description>Purpose
Knowledge is limited regarding the prevalence and persistence of chemotherapy‐induced leukoencephalopathy in childhood sarcoma patients. This study explored the presence, clinical relevance, and potential risk factors of leukoencephalopathy in childhood bone and soft tissue sarcoma survivors, treated with intravenous chemotherapy.
Methods
We acquired cross‐sectional neurocognitive data in adult survivors (n = 34) (median age at diagnosis [AaD] = 13.32 years, age range = 16‐35 years) and healthy age‐matched controls (n = 34). Additionally, magnetic resonance imaging included T2‐weighted FLAIR (leukoencephalopathy Fazekas rating), multiexponential T2 relaxation (MET2), and multishell diffusion MRI to estimate myelin integrity‐related metrics and fluid movement restrictions. Finally, chemotherapy subgroups (methotrexate, alkylating agents, or combination), AaD, and Apoε and MTHFRC677T polymorphisms were explored as potential risk factors for leukoencephalopathy.
Results
At the group level, quality of life, working memory, processing speed, and visual memory were significantly lower in patients compared to controls. Furthermore, long‐term leukoencephalopathy was observed in 27.2% of the childhood sarcoma survivors, which was related to attentional processing speed. Lesions were related to diffusion‐derived, but not to myelin‐sensitive metrics. A significant interaction effect between AaD and chemotherapy group demonstrated more lesions in case of high‐dose methotrexate (HD‐MTX) (F = 3.434, P = .047). However, patients treated with alkylating agents (without HD‐MTX) also showed lesions in younger patients. Genetic predictors were nonsignificant.
Conclusion and implication
This study suggests long‐term leukoencephalopathy with possibly underlying changes in vasculature, inflammation, or axonal injury, but not necessarily long‐term demyelination. Such lesions could affect processing speed, and as such long‐term daily life functioning of these patients.</description><identifier>ISSN: 1545-5009</identifier><identifier>EISSN: 1545-5017</identifier><identifier>DOI: 10.1002/pbc.27893</identifier><identifier>PMID: 31276297</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Administration, Intravenous ; Adolescent ; Adult ; Alkylating agents ; Alkylation ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Cancer Survivors ; Chemotherapy ; Childhood ; childhood sarcoma ; Children ; Cognition ; Cognition Disorders - chemically induced ; Cross-Sectional Studies ; Demyelination ; Diffusion rate ; Female ; genetics ; Hematology ; high‐dose chemotherapy ; Humans ; Information processing ; Intravenous administration ; Lesions ; Leukoencephalopathies - chemically induced ; Leukoencephalopathy ; Magnetic resonance imaging ; Male ; Memory ; Methotrexate ; Myelin ; neurocognition ; NMR ; Nuclear magnetic resonance ; Oncology ; Pediatrics ; Quality of life ; Risk factors ; Sarcoma ; Sarcoma - drug therapy ; Short term memory ; Soft tissue sarcoma ; Young Adult</subject><ispartof>Pediatric blood & cancer, 2019-10, Vol.66 (10), p.e27893-n/a</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3533-960bdd068461097aebca377fffd4e7d5175e1dd492be216b07d4eca82e7d41763</citedby><cites>FETCH-LOGICAL-c3533-960bdd068461097aebca377fffd4e7d5175e1dd492be216b07d4eca82e7d41763</cites><orcidid>0000-0001-5644-424X ; 0000-0002-1177-4680 ; 0000-0002-1575-0889 ; 0000-0002-4480-8330 ; 0000-0001-9264-2593 ; 0000-0001-7451-5355</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fpbc.27893$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fpbc.27893$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31276297$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sleurs, Charlotte</creatorcontrib><creatorcontrib>Lemiere, Jurgen</creatorcontrib><creatorcontrib>Radwan, Ahmed</creatorcontrib><creatorcontrib>Verly, Marjolein</creatorcontrib><creatorcontrib>Elens, Iris</creatorcontrib><creatorcontrib>Renard, Marleen</creatorcontrib><creatorcontrib>Jacobs, Sandra</creatorcontrib><creatorcontrib>Sunaert, Stefan</creatorcontrib><creatorcontrib>Deprez, Sabine</creatorcontrib><creatorcontrib>Uyttebroeck, Anne</creatorcontrib><title>Long‐term leukoencephalopathy and neurocognitive functioning in childhood sarcoma patients treated with high‐dose intravenous chemotherapy</title><title>Pediatric blood & cancer</title><addtitle>Pediatr Blood Cancer</addtitle><description>Purpose
Knowledge is limited regarding the prevalence and persistence of chemotherapy‐induced leukoencephalopathy in childhood sarcoma patients. This study explored the presence, clinical relevance, and potential risk factors of leukoencephalopathy in childhood bone and soft tissue sarcoma survivors, treated with intravenous chemotherapy.
Methods
We acquired cross‐sectional neurocognitive data in adult survivors (n = 34) (median age at diagnosis [AaD] = 13.32 years, age range = 16‐35 years) and healthy age‐matched controls (n = 34). Additionally, magnetic resonance imaging included T2‐weighted FLAIR (leukoencephalopathy Fazekas rating), multiexponential T2 relaxation (MET2), and multishell diffusion MRI to estimate myelin integrity‐related metrics and fluid movement restrictions. Finally, chemotherapy subgroups (methotrexate, alkylating agents, or combination), AaD, and Apoε and MTHFRC677T polymorphisms were explored as potential risk factors for leukoencephalopathy.
Results
At the group level, quality of life, working memory, processing speed, and visual memory were significantly lower in patients compared to controls. Furthermore, long‐term leukoencephalopathy was observed in 27.2% of the childhood sarcoma survivors, which was related to attentional processing speed. Lesions were related to diffusion‐derived, but not to myelin‐sensitive metrics. A significant interaction effect between AaD and chemotherapy group demonstrated more lesions in case of high‐dose methotrexate (HD‐MTX) (F = 3.434, P = .047). However, patients treated with alkylating agents (without HD‐MTX) also showed lesions in younger patients. Genetic predictors were nonsignificant.
Conclusion and implication
This study suggests long‐term leukoencephalopathy with possibly underlying changes in vasculature, inflammation, or axonal injury, but not necessarily long‐term demyelination. Such lesions could affect processing speed, and as such long‐term daily life functioning of these patients.</description><subject>Administration, Intravenous</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Alkylating agents</subject><subject>Alkylation</subject><subject>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Cancer Survivors</subject><subject>Chemotherapy</subject><subject>Childhood</subject><subject>childhood sarcoma</subject><subject>Children</subject><subject>Cognition</subject><subject>Cognition Disorders - chemically induced</subject><subject>Cross-Sectional Studies</subject><subject>Demyelination</subject><subject>Diffusion rate</subject><subject>Female</subject><subject>genetics</subject><subject>Hematology</subject><subject>high‐dose chemotherapy</subject><subject>Humans</subject><subject>Information processing</subject><subject>Intravenous administration</subject><subject>Lesions</subject><subject>Leukoencephalopathies - chemically induced</subject><subject>Leukoencephalopathy</subject><subject>Magnetic resonance imaging</subject><subject>Male</subject><subject>Memory</subject><subject>Methotrexate</subject><subject>Myelin</subject><subject>neurocognition</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Oncology</subject><subject>Pediatrics</subject><subject>Quality of life</subject><subject>Risk factors</subject><subject>Sarcoma</subject><subject>Sarcoma - drug therapy</subject><subject>Short term memory</subject><subject>Soft tissue sarcoma</subject><subject>Young Adult</subject><issn>1545-5009</issn><issn>1545-5017</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc9O3DAQxq0KVOi2B16gssSFHhb8J4mTY1lRirQSHNpz5NiTjSGxU9tZtDeeAPUZ-yQYduFQidOMZn7fNyN9CB1RckoJYWdjo06ZKCv-AR3SPMvnOaFi760n1QH6FMJtQguSlx_RAadMFKwSh-hx6ezq38PfCH7APUx3DqyCsZO9G2XsNlhajS1M3im3siaaNeB2sioaZ41dYWOx6kyvO-c0DtIrN0iclAZsDDh6kBE0vjexw51ZdemSdgGSLHq5BuumkPQwuNiBl-PmM9pvZR_gy67O0O8fF78WP-fL68urxfflXPGc83lVkEZrUpRZQUklJDRKciHattUZCJ1TkQPVOqtYA4wWDRFprmTJ0jKjouAzdLL1Hb37M0GI9WCCgr6XFtJPNWPpDCEiYwk9_g-9dZO36btEiZJwTss8Ud-2lPIuBA9tPXozSL-pKamfQ6pTSPVLSIn9unOcmgH0G_maSgLOtsC96WHzvlN9c77YWj4BkMmhOw</recordid><startdate>201910</startdate><enddate>201910</enddate><creator>Sleurs, Charlotte</creator><creator>Lemiere, Jurgen</creator><creator>Radwan, Ahmed</creator><creator>Verly, Marjolein</creator><creator>Elens, Iris</creator><creator>Renard, Marleen</creator><creator>Jacobs, Sandra</creator><creator>Sunaert, Stefan</creator><creator>Deprez, Sabine</creator><creator>Uyttebroeck, Anne</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>7TO</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5644-424X</orcidid><orcidid>https://orcid.org/0000-0002-1177-4680</orcidid><orcidid>https://orcid.org/0000-0002-1575-0889</orcidid><orcidid>https://orcid.org/0000-0002-4480-8330</orcidid><orcidid>https://orcid.org/0000-0001-9264-2593</orcidid><orcidid>https://orcid.org/0000-0001-7451-5355</orcidid></search><sort><creationdate>201910</creationdate><title>Long‐term leukoencephalopathy and neurocognitive functioning in childhood sarcoma patients treated with high‐dose intravenous chemotherapy</title><author>Sleurs, Charlotte ; Lemiere, Jurgen ; Radwan, Ahmed ; Verly, Marjolein ; Elens, Iris ; Renard, Marleen ; Jacobs, Sandra ; Sunaert, Stefan ; Deprez, Sabine ; Uyttebroeck, Anne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3533-960bdd068461097aebca377fffd4e7d5175e1dd492be216b07d4eca82e7d41763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Administration, Intravenous</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Alkylating agents</topic><topic>Alkylation</topic><topic>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Cancer Survivors</topic><topic>Chemotherapy</topic><topic>Childhood</topic><topic>childhood sarcoma</topic><topic>Children</topic><topic>Cognition</topic><topic>Cognition Disorders - chemically induced</topic><topic>Cross-Sectional Studies</topic><topic>Demyelination</topic><topic>Diffusion rate</topic><topic>Female</topic><topic>genetics</topic><topic>Hematology</topic><topic>high‐dose chemotherapy</topic><topic>Humans</topic><topic>Information processing</topic><topic>Intravenous administration</topic><topic>Lesions</topic><topic>Leukoencephalopathies - chemically induced</topic><topic>Leukoencephalopathy</topic><topic>Magnetic resonance imaging</topic><topic>Male</topic><topic>Memory</topic><topic>Methotrexate</topic><topic>Myelin</topic><topic>neurocognition</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Oncology</topic><topic>Pediatrics</topic><topic>Quality of life</topic><topic>Risk factors</topic><topic>Sarcoma</topic><topic>Sarcoma - drug therapy</topic><topic>Short term memory</topic><topic>Soft tissue sarcoma</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sleurs, Charlotte</creatorcontrib><creatorcontrib>Lemiere, Jurgen</creatorcontrib><creatorcontrib>Radwan, Ahmed</creatorcontrib><creatorcontrib>Verly, Marjolein</creatorcontrib><creatorcontrib>Elens, Iris</creatorcontrib><creatorcontrib>Renard, Marleen</creatorcontrib><creatorcontrib>Jacobs, Sandra</creatorcontrib><creatorcontrib>Sunaert, Stefan</creatorcontrib><creatorcontrib>Deprez, Sabine</creatorcontrib><creatorcontrib>Uyttebroeck, Anne</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric blood & cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sleurs, Charlotte</au><au>Lemiere, Jurgen</au><au>Radwan, Ahmed</au><au>Verly, Marjolein</au><au>Elens, Iris</au><au>Renard, Marleen</au><au>Jacobs, Sandra</au><au>Sunaert, Stefan</au><au>Deprez, Sabine</au><au>Uyttebroeck, Anne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐term leukoencephalopathy and neurocognitive functioning in childhood sarcoma patients treated with high‐dose intravenous chemotherapy</atitle><jtitle>Pediatric blood & cancer</jtitle><addtitle>Pediatr Blood Cancer</addtitle><date>2019-10</date><risdate>2019</risdate><volume>66</volume><issue>10</issue><spage>e27893</spage><epage>n/a</epage><pages>e27893-n/a</pages><issn>1545-5009</issn><eissn>1545-5017</eissn><abstract>Purpose
Knowledge is limited regarding the prevalence and persistence of chemotherapy‐induced leukoencephalopathy in childhood sarcoma patients. This study explored the presence, clinical relevance, and potential risk factors of leukoencephalopathy in childhood bone and soft tissue sarcoma survivors, treated with intravenous chemotherapy.
Methods
We acquired cross‐sectional neurocognitive data in adult survivors (n = 34) (median age at diagnosis [AaD] = 13.32 years, age range = 16‐35 years) and healthy age‐matched controls (n = 34). Additionally, magnetic resonance imaging included T2‐weighted FLAIR (leukoencephalopathy Fazekas rating), multiexponential T2 relaxation (MET2), and multishell diffusion MRI to estimate myelin integrity‐related metrics and fluid movement restrictions. Finally, chemotherapy subgroups (methotrexate, alkylating agents, or combination), AaD, and Apoε and MTHFRC677T polymorphisms were explored as potential risk factors for leukoencephalopathy.
Results
At the group level, quality of life, working memory, processing speed, and visual memory were significantly lower in patients compared to controls. Furthermore, long‐term leukoencephalopathy was observed in 27.2% of the childhood sarcoma survivors, which was related to attentional processing speed. Lesions were related to diffusion‐derived, but not to myelin‐sensitive metrics. A significant interaction effect between AaD and chemotherapy group demonstrated more lesions in case of high‐dose methotrexate (HD‐MTX) (F = 3.434, P = .047). However, patients treated with alkylating agents (without HD‐MTX) also showed lesions in younger patients. Genetic predictors were nonsignificant.
Conclusion and implication
This study suggests long‐term leukoencephalopathy with possibly underlying changes in vasculature, inflammation, or axonal injury, but not necessarily long‐term demyelination. Such lesions could affect processing speed, and as such long‐term daily life functioning of these patients.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31276297</pmid><doi>10.1002/pbc.27893</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-5644-424X</orcidid><orcidid>https://orcid.org/0000-0002-1177-4680</orcidid><orcidid>https://orcid.org/0000-0002-1575-0889</orcidid><orcidid>https://orcid.org/0000-0002-4480-8330</orcidid><orcidid>https://orcid.org/0000-0001-9264-2593</orcidid><orcidid>https://orcid.org/0000-0001-7451-5355</orcidid></addata></record> |
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| subjects | Administration, Intravenous Adolescent Adult Alkylating agents Alkylation Antineoplastic Combined Chemotherapy Protocols - administration & dosage Antineoplastic Combined Chemotherapy Protocols - adverse effects Cancer Survivors Chemotherapy Childhood childhood sarcoma Children Cognition Cognition Disorders - chemically induced Cross-Sectional Studies Demyelination Diffusion rate Female genetics Hematology high‐dose chemotherapy Humans Information processing Intravenous administration Lesions Leukoencephalopathies - chemically induced Leukoencephalopathy Magnetic resonance imaging Male Memory Methotrexate Myelin neurocognition NMR Nuclear magnetic resonance Oncology Pediatrics Quality of life Risk factors Sarcoma Sarcoma - drug therapy Short term memory Soft tissue sarcoma Young Adult |
| title | Long‐term leukoencephalopathy and neurocognitive functioning in childhood sarcoma patients treated with high‐dose intravenous chemotherapy |
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