Sex-Specific Associations Between Chemotherapy, Chronic Conditions, and Neurocognitive Impairment in Acute Lymphoblastic Leukemia Survivors: A Report From the Childhood Cancer Survivor Study
Abstract Background The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only. Methods This cross-sectional study included 1207 ALL survivors (54.0% female; mea...
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| Veröffentlicht in: | JNCI : Journal of the National Cancer Institute 2021-05, Vol.113 (5), p.588-596 |
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| creator | van der Plas, Ellen Qiu, Weiyu Nieman, Brian J Yasui, Yutaka Liu, Qi Dixon, Stephanie B Kadan-Lottick, Nina S Weldon, Christopher B Weil, Brent R Jacola, Lisa M Gibson, Todd M Leisenring, Wendy Oeffinger, Kevin Hudson, Melissa M Robison, Leslie L Armstrong, Gregory T Krull, Kevin R |
| description | Abstract
Background
The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only.
Methods
This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided.
Results
Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.31 to 2.74; females: 12.5% vs 17.6%; OR = 1.50, 95% CI = 1.07 to 2.14), as well as impaired memory (males: 11.6% vs 19.9%, OR = 1.89, CI = 1.31 to 2.74; females: 14.78% vs 25.4%, OR = 1.96, 95% CI = 1.43 to 2.70, respectively). Among male survivors, impaired task efficiency was associated with 2-4 neurologic conditions (OR = 4.33, 95% CI = 1.76 to 10.68) and with pulmonary conditions (OR = 4.99, 95% CI = 1.51 to 16.50), and impaired memory was associated with increased cumulative dose of intrathecal methotrexate (OR = 1.68, 95% CI = 1.16 to 2.46) and with exposure to dexamethasone (OR = 2.44, 95% CI = 1.19 to 5.01). In female survivors, grade 2-4 endocrine conditions were associated with higher risk of impaired task efficiency (OR = 2.19, 95% CI = 1.20 to 3.97) and memory (OR = 2.26, 95% CI = 1.31 to 3.92).
Conclusion
Neurocognitive impairment is associated with methotrexate, dexamethasone, and chronic health conditions in a sex-specific manner, highlighting the need to investigate physiological mechanisms and monitor impact through survivorship. |
| doi_str_mv | 10.1093/jnci/djaa136 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8096369</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/jnci/djaa136</oup_id><sourcerecordid>2440470942</sourcerecordid><originalsourceid>FETCH-LOGICAL-c510t-7dd7867fb1a3e809e8bf46fa7b5a8cc2e7a56dec3b28bb4fe2ad10616e3f82093</originalsourceid><addsrcrecordid>eNp9kk-PEyEYxidG43ZXb54NiQf30HGBYf7twaROXN2k0cTqmTDwzpY6AyMM1X45P5t0Wxv1IBcC_PI870OeJHlG8CuC6-xqY6S-UhshSFY8SGaEFTilBOcPkxnGtEyrqmRnybn3GxxXTdnj5CyjVUUxI7Pk5wp-pKsRpO60RAvvrdRi0tZ49Aam7wAGNWsY7LQGJ8bdPJ6cNRFtrFH6HpwjYRT6AMFZae9MvNwCuh1God0AZkLaoIUME6DlbhjXtu2Fn6LAEsJXGLRAq-C2emudv0YL9AlG6yZ04-yAome0071aW6tQI4wEd6LRagpq9yR51Inew9PjfpF8uXn7uXmfLj--u20Wy1TmBE9pqVRZFWXXEpFBhWuo2o4VnSjbXFRSUihFXiiQWUurtmUdUKEILkgBWRc_qs4uktcH3TG0AygZcznR89HpQbgdt0Lzv1-MXvM7u-XRrMiKvcDlUcDZbwH8xAftJfS9MGCD55QxzEpcMxrRF_-gGxucifE4zTNCa0rvqfmBks5676A7DUMw3xeD74vBj8WI-PM_A5zg302IwMsDYMP4f6lfXZDIiw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2531292242</pqid></control><display><type>article</type><title>Sex-Specific Associations Between Chemotherapy, Chronic Conditions, and Neurocognitive Impairment in Acute Lymphoblastic Leukemia Survivors: A Report From the Childhood Cancer Survivor Study</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>van der Plas, Ellen ; Qiu, Weiyu ; Nieman, Brian J ; Yasui, Yutaka ; Liu, Qi ; Dixon, Stephanie B ; Kadan-Lottick, Nina S ; Weldon, Christopher B ; Weil, Brent R ; Jacola, Lisa M ; Gibson, Todd M ; Leisenring, Wendy ; Oeffinger, Kevin ; Hudson, Melissa M ; Robison, Leslie L ; Armstrong, Gregory T ; Krull, Kevin R</creator><creatorcontrib>van der Plas, Ellen ; Qiu, Weiyu ; Nieman, Brian J ; Yasui, Yutaka ; Liu, Qi ; Dixon, Stephanie B ; Kadan-Lottick, Nina S ; Weldon, Christopher B ; Weil, Brent R ; Jacola, Lisa M ; Gibson, Todd M ; Leisenring, Wendy ; Oeffinger, Kevin ; Hudson, Melissa M ; Robison, Leslie L ; Armstrong, Gregory T ; Krull, Kevin R</creatorcontrib><description>Abstract
Background
The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only.
Methods
This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided.
Results
Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.31 to 2.74; females: 12.5% vs 17.6%; OR = 1.50, 95% CI = 1.07 to 2.14), as well as impaired memory (males: 11.6% vs 19.9%, OR = 1.89, CI = 1.31 to 2.74; females: 14.78% vs 25.4%, OR = 1.96, 95% CI = 1.43 to 2.70, respectively). Among male survivors, impaired task efficiency was associated with 2-4 neurologic conditions (OR = 4.33, 95% CI = 1.76 to 10.68) and with pulmonary conditions (OR = 4.99, 95% CI = 1.51 to 16.50), and impaired memory was associated with increased cumulative dose of intrathecal methotrexate (OR = 1.68, 95% CI = 1.16 to 2.46) and with exposure to dexamethasone (OR = 2.44, 95% CI = 1.19 to 5.01). In female survivors, grade 2-4 endocrine conditions were associated with higher risk of impaired task efficiency (OR = 2.19, 95% CI = 1.20 to 3.97) and memory (OR = 2.26, 95% CI = 1.31 to 3.92).
Conclusion
Neurocognitive impairment is associated with methotrexate, dexamethasone, and chronic health conditions in a sex-specific manner, highlighting the need to investigate physiological mechanisms and monitor impact through survivorship.</description><identifier>ISSN: 0027-8874</identifier><identifier>EISSN: 1460-2105</identifier><identifier>DOI: 10.1093/jnci/djaa136</identifier><identifier>PMID: 32882041</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Acute lymphoblastic leukemia ; Adult ; Cancer ; Cancer Survivors ; Chemotherapy ; Child ; Children ; Chronic conditions ; Chronic Disease ; Chronic illnesses ; Cognition ; Confidence intervals ; Cross-Sectional Studies ; Dexamethasone ; Efficiency ; Exposure ; Female ; Females ; Humans ; Impairment ; Leukemia ; Lymphatic leukemia ; Male ; Males ; Methotrexate ; Middle Aged ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology ; Sex ; Siblings ; Statistical analysis ; Statistical tests ; Survival ; Survivors ; Terminology</subject><ispartof>JNCI : Journal of the National Cancer Institute, 2021-05, Vol.113 (5), p.588-596</ispartof><rights>The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-7dd7867fb1a3e809e8bf46fa7b5a8cc2e7a56dec3b28bb4fe2ad10616e3f82093</citedby><cites>FETCH-LOGICAL-c510t-7dd7867fb1a3e809e8bf46fa7b5a8cc2e7a56dec3b28bb4fe2ad10616e3f82093</cites><orcidid>0000-0002-7717-8638 ; 0000-0002-7208-515X ; 0000-0001-6984-2407 ; 0000-0003-3901-3274 ; 0000-0001-7405-0906 ; 0000-0002-7490-6636 ; 0000-0002-0476-7001 ; 0000-0003-2698-5816</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32882041$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Plas, Ellen</creatorcontrib><creatorcontrib>Qiu, Weiyu</creatorcontrib><creatorcontrib>Nieman, Brian J</creatorcontrib><creatorcontrib>Yasui, Yutaka</creatorcontrib><creatorcontrib>Liu, Qi</creatorcontrib><creatorcontrib>Dixon, Stephanie B</creatorcontrib><creatorcontrib>Kadan-Lottick, Nina S</creatorcontrib><creatorcontrib>Weldon, Christopher B</creatorcontrib><creatorcontrib>Weil, Brent R</creatorcontrib><creatorcontrib>Jacola, Lisa M</creatorcontrib><creatorcontrib>Gibson, Todd M</creatorcontrib><creatorcontrib>Leisenring, Wendy</creatorcontrib><creatorcontrib>Oeffinger, Kevin</creatorcontrib><creatorcontrib>Hudson, Melissa M</creatorcontrib><creatorcontrib>Robison, Leslie L</creatorcontrib><creatorcontrib>Armstrong, Gregory T</creatorcontrib><creatorcontrib>Krull, Kevin R</creatorcontrib><title>Sex-Specific Associations Between Chemotherapy, Chronic Conditions, and Neurocognitive Impairment in Acute Lymphoblastic Leukemia Survivors: A Report From the Childhood Cancer Survivor Study</title><title>JNCI : Journal of the National Cancer Institute</title><addtitle>J Natl Cancer Inst</addtitle><description>Abstract
Background
The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only.
Methods
This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided.
Results
Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.31 to 2.74; females: 12.5% vs 17.6%; OR = 1.50, 95% CI = 1.07 to 2.14), as well as impaired memory (males: 11.6% vs 19.9%, OR = 1.89, CI = 1.31 to 2.74; females: 14.78% vs 25.4%, OR = 1.96, 95% CI = 1.43 to 2.70, respectively). Among male survivors, impaired task efficiency was associated with 2-4 neurologic conditions (OR = 4.33, 95% CI = 1.76 to 10.68) and with pulmonary conditions (OR = 4.99, 95% CI = 1.51 to 16.50), and impaired memory was associated with increased cumulative dose of intrathecal methotrexate (OR = 1.68, 95% CI = 1.16 to 2.46) and with exposure to dexamethasone (OR = 2.44, 95% CI = 1.19 to 5.01). In female survivors, grade 2-4 endocrine conditions were associated with higher risk of impaired task efficiency (OR = 2.19, 95% CI = 1.20 to 3.97) and memory (OR = 2.26, 95% CI = 1.31 to 3.92).
Conclusion
Neurocognitive impairment is associated with methotrexate, dexamethasone, and chronic health conditions in a sex-specific manner, highlighting the need to investigate physiological mechanisms and monitor impact through survivorship.</description><subject>Acute lymphoblastic leukemia</subject><subject>Adult</subject><subject>Cancer</subject><subject>Cancer Survivors</subject><subject>Chemotherapy</subject><subject>Child</subject><subject>Children</subject><subject>Chronic conditions</subject><subject>Chronic Disease</subject><subject>Chronic illnesses</subject><subject>Cognition</subject><subject>Confidence intervals</subject><subject>Cross-Sectional Studies</subject><subject>Dexamethasone</subject><subject>Efficiency</subject><subject>Exposure</subject><subject>Female</subject><subject>Females</subject><subject>Humans</subject><subject>Impairment</subject><subject>Leukemia</subject><subject>Lymphatic leukemia</subject><subject>Male</subject><subject>Males</subject><subject>Methotrexate</subject><subject>Middle Aged</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology</subject><subject>Sex</subject><subject>Siblings</subject><subject>Statistical analysis</subject><subject>Statistical tests</subject><subject>Survival</subject><subject>Survivors</subject><subject>Terminology</subject><issn>0027-8874</issn><issn>1460-2105</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk-PEyEYxidG43ZXb54NiQf30HGBYf7twaROXN2k0cTqmTDwzpY6AyMM1X45P5t0Wxv1IBcC_PI870OeJHlG8CuC6-xqY6S-UhshSFY8SGaEFTilBOcPkxnGtEyrqmRnybn3GxxXTdnj5CyjVUUxI7Pk5wp-pKsRpO60RAvvrdRi0tZ49Aam7wAGNWsY7LQGJ8bdPJ6cNRFtrFH6HpwjYRT6AMFZae9MvNwCuh1God0AZkLaoIUME6DlbhjXtu2Fn6LAEsJXGLRAq-C2emudv0YL9AlG6yZ04-yAome0071aW6tQI4wEd6LRagpq9yR51Inew9PjfpF8uXn7uXmfLj--u20Wy1TmBE9pqVRZFWXXEpFBhWuo2o4VnSjbXFRSUihFXiiQWUurtmUdUKEILkgBWRc_qs4uktcH3TG0AygZcznR89HpQbgdt0Lzv1-MXvM7u-XRrMiKvcDlUcDZbwH8xAftJfS9MGCD55QxzEpcMxrRF_-gGxucifE4zTNCa0rvqfmBks5676A7DUMw3xeD74vBj8WI-PM_A5zg302IwMsDYMP4f6lfXZDIiw</recordid><startdate>20210504</startdate><enddate>20210504</enddate><creator>van der Plas, Ellen</creator><creator>Qiu, Weiyu</creator><creator>Nieman, Brian J</creator><creator>Yasui, Yutaka</creator><creator>Liu, Qi</creator><creator>Dixon, Stephanie B</creator><creator>Kadan-Lottick, Nina S</creator><creator>Weldon, Christopher B</creator><creator>Weil, Brent R</creator><creator>Jacola, Lisa M</creator><creator>Gibson, Todd M</creator><creator>Leisenring, Wendy</creator><creator>Oeffinger, Kevin</creator><creator>Hudson, Melissa M</creator><creator>Robison, Leslie L</creator><creator>Armstrong, Gregory T</creator><creator>Krull, Kevin R</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</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>7TO</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7717-8638</orcidid><orcidid>https://orcid.org/0000-0002-7208-515X</orcidid><orcidid>https://orcid.org/0000-0001-6984-2407</orcidid><orcidid>https://orcid.org/0000-0003-3901-3274</orcidid><orcidid>https://orcid.org/0000-0001-7405-0906</orcidid><orcidid>https://orcid.org/0000-0002-7490-6636</orcidid><orcidid>https://orcid.org/0000-0002-0476-7001</orcidid><orcidid>https://orcid.org/0000-0003-2698-5816</orcidid></search><sort><creationdate>20210504</creationdate><title>Sex-Specific Associations Between Chemotherapy, Chronic Conditions, and Neurocognitive Impairment in Acute Lymphoblastic Leukemia Survivors: A Report From the Childhood Cancer Survivor Study</title><author>van der Plas, Ellen ; Qiu, Weiyu ; Nieman, Brian J ; Yasui, Yutaka ; Liu, Qi ; Dixon, Stephanie B ; Kadan-Lottick, Nina S ; Weldon, Christopher B ; Weil, Brent R ; Jacola, Lisa M ; Gibson, Todd M ; Leisenring, Wendy ; Oeffinger, Kevin ; Hudson, Melissa M ; Robison, Leslie L ; Armstrong, Gregory T ; Krull, Kevin R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-7dd7867fb1a3e809e8bf46fa7b5a8cc2e7a56dec3b28bb4fe2ad10616e3f82093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acute lymphoblastic leukemia</topic><topic>Adult</topic><topic>Cancer</topic><topic>Cancer Survivors</topic><topic>Chemotherapy</topic><topic>Child</topic><topic>Children</topic><topic>Chronic conditions</topic><topic>Chronic Disease</topic><topic>Chronic illnesses</topic><topic>Cognition</topic><topic>Confidence intervals</topic><topic>Cross-Sectional Studies</topic><topic>Dexamethasone</topic><topic>Efficiency</topic><topic>Exposure</topic><topic>Female</topic><topic>Females</topic><topic>Humans</topic><topic>Impairment</topic><topic>Leukemia</topic><topic>Lymphatic leukemia</topic><topic>Male</topic><topic>Males</topic><topic>Methotrexate</topic><topic>Middle Aged</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology</topic><topic>Sex</topic><topic>Siblings</topic><topic>Statistical analysis</topic><topic>Statistical tests</topic><topic>Survival</topic><topic>Survivors</topic><topic>Terminology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van der Plas, Ellen</creatorcontrib><creatorcontrib>Qiu, Weiyu</creatorcontrib><creatorcontrib>Nieman, Brian J</creatorcontrib><creatorcontrib>Yasui, Yutaka</creatorcontrib><creatorcontrib>Liu, Qi</creatorcontrib><creatorcontrib>Dixon, Stephanie B</creatorcontrib><creatorcontrib>Kadan-Lottick, Nina S</creatorcontrib><creatorcontrib>Weldon, Christopher B</creatorcontrib><creatorcontrib>Weil, Brent R</creatorcontrib><creatorcontrib>Jacola, Lisa M</creatorcontrib><creatorcontrib>Gibson, Todd M</creatorcontrib><creatorcontrib>Leisenring, Wendy</creatorcontrib><creatorcontrib>Oeffinger, Kevin</creatorcontrib><creatorcontrib>Hudson, Melissa M</creatorcontrib><creatorcontrib>Robison, Leslie L</creatorcontrib><creatorcontrib>Armstrong, Gregory T</creatorcontrib><creatorcontrib>Krull, Kevin R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JNCI : Journal of the National Cancer Institute</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van der Plas, Ellen</au><au>Qiu, Weiyu</au><au>Nieman, Brian J</au><au>Yasui, Yutaka</au><au>Liu, Qi</au><au>Dixon, Stephanie B</au><au>Kadan-Lottick, Nina S</au><au>Weldon, Christopher B</au><au>Weil, Brent R</au><au>Jacola, Lisa M</au><au>Gibson, Todd M</au><au>Leisenring, Wendy</au><au>Oeffinger, Kevin</au><au>Hudson, Melissa M</au><au>Robison, Leslie L</au><au>Armstrong, Gregory T</au><au>Krull, Kevin R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex-Specific Associations Between Chemotherapy, Chronic Conditions, and Neurocognitive Impairment in Acute Lymphoblastic Leukemia Survivors: A Report From the Childhood Cancer Survivor Study</atitle><jtitle>JNCI : Journal of the National Cancer Institute</jtitle><addtitle>J Natl Cancer Inst</addtitle><date>2021-05-04</date><risdate>2021</risdate><volume>113</volume><issue>5</issue><spage>588</spage><epage>596</epage><pages>588-596</pages><issn>0027-8874</issn><eissn>1460-2105</eissn><abstract>Abstract
Background
The purpose was to examine associations between treatment and chronic health conditions with neurocognitive impairment survivors of acute lymphoblastic leukemia (ALL) treated with chemotherapy only.
Methods
This cross-sectional study included 1207 ALL survivors (54.0% female; mean age 30.6 years) and 2273 siblings (56.9% female; mean age 47.6 years), who completed the Childhood Cancer Survivor Study Neurocognitive Questionnaire. Multivariable logistic regression compared prevalence of neurocognitive impairment between survivors and siblings by sex. Associations between neurocognitive impairment with treatment exposures and chronic conditions (graded according to Common Terminology Criteria for Adverse Events) were also examined. Statistical tests were 2-sided.
Results
Relative to same-sex siblings, male and female ALL survivors reported increased prevalence of impaired task efficiency (males: 11.7% vs 16.9%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.31 to 2.74; females: 12.5% vs 17.6%; OR = 1.50, 95% CI = 1.07 to 2.14), as well as impaired memory (males: 11.6% vs 19.9%, OR = 1.89, CI = 1.31 to 2.74; females: 14.78% vs 25.4%, OR = 1.96, 95% CI = 1.43 to 2.70, respectively). Among male survivors, impaired task efficiency was associated with 2-4 neurologic conditions (OR = 4.33, 95% CI = 1.76 to 10.68) and with pulmonary conditions (OR = 4.99, 95% CI = 1.51 to 16.50), and impaired memory was associated with increased cumulative dose of intrathecal methotrexate (OR = 1.68, 95% CI = 1.16 to 2.46) and with exposure to dexamethasone (OR = 2.44, 95% CI = 1.19 to 5.01). In female survivors, grade 2-4 endocrine conditions were associated with higher risk of impaired task efficiency (OR = 2.19, 95% CI = 1.20 to 3.97) and memory (OR = 2.26, 95% CI = 1.31 to 3.92).
Conclusion
Neurocognitive impairment is associated with methotrexate, dexamethasone, and chronic health conditions in a sex-specific manner, highlighting the need to investigate physiological mechanisms and monitor impact through survivorship.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>32882041</pmid><doi>10.1093/jnci/djaa136</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7717-8638</orcidid><orcidid>https://orcid.org/0000-0002-7208-515X</orcidid><orcidid>https://orcid.org/0000-0001-6984-2407</orcidid><orcidid>https://orcid.org/0000-0003-3901-3274</orcidid><orcidid>https://orcid.org/0000-0001-7405-0906</orcidid><orcidid>https://orcid.org/0000-0002-7490-6636</orcidid><orcidid>https://orcid.org/0000-0002-0476-7001</orcidid><orcidid>https://orcid.org/0000-0003-2698-5816</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0027-8874 |
| ispartof | JNCI : Journal of the National Cancer Institute, 2021-05, Vol.113 (5), p.588-596 |
| issn | 0027-8874 1460-2105 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8096369 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Acute lymphoblastic leukemia Adult Cancer Cancer Survivors Chemotherapy Child Children Chronic conditions Chronic Disease Chronic illnesses Cognition Confidence intervals Cross-Sectional Studies Dexamethasone Efficiency Exposure Female Females Humans Impairment Leukemia Lymphatic leukemia Male Males Methotrexate Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology Sex Siblings Statistical analysis Statistical tests Survival Survivors Terminology |
| title | Sex-Specific Associations Between Chemotherapy, Chronic Conditions, and Neurocognitive Impairment in Acute Lymphoblastic Leukemia Survivors: A Report From the Childhood Cancer Survivor Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T00%3A07%3A42IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Sex-Specific%20Associations%20Between%20Chemotherapy,%20Chronic%20Conditions,%20and%20Neurocognitive%20Impairment%20in%20Acute%20Lymphoblastic%20Leukemia%20Survivors:%20A%20Report%20From%20the%20Childhood%20Cancer%20Survivor%20Study&rft.jtitle=JNCI%20:%20Journal%20of%20the%20National%20Cancer%20Institute&rft.au=van%20der%20Plas,%20Ellen&rft.date=2021-05-04&rft.volume=113&rft.issue=5&rft.spage=588&rft.epage=596&rft.pages=588-596&rft.issn=0027-8874&rft.eissn=1460-2105&rft_id=info:doi/10.1093/jnci/djaa136&rft_dat=%3Cproquest_pubme%3E2440470942%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2531292242&rft_id=info:pmid/32882041&rft_oup_id=10.1093/jnci/djaa136&rfr_iscdi=true |