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Childhood ALL: Increased Survival Leads to a Greater Emphasis on Preserving Neurocognitive Function

GregoryAuneby Gregory Aune, MD, PhD, CKN Editor


Childhood Cancer Survivors have their own unique set of issues that often go unaddressed by health care professionals once treatment has ended and the child enters adulthood.  Although the last 20 years have seen growth in survivorship research, this research is rarely filtered down to the people who need it most – the survivors and their families.  Dr. Gregory Aune, Pediatric Oncologist, researcher, childhood cancer survivor and advocate, has taken on the position of CKN Editor, Knowledge Translation – Childhood Cancer Survivorship.  His goal is simple:  to help empower childhood cancer survivors to start a dialogue with their doctors by publishing short, easy-to-read research study summaries, like this one.


THE HEADLINE:  Chemotherapy Exposure Impacts Cognitive Processes

THE RESEARCH: Neurocognitive Functioning of Children Treated for High-Risk B-Acute Lymphoblastic Leukemia Randomly Assigned to Different Methotrexate and Corticosteroid Treatment Strategies: A Report From the Children’s Oncology Group.  As part of a clinical trial for high-risk B-acute lymphoblastic leukemia (B-ALL) conducted by Children’s Oncology Group (COG), U.S. researchers performed neurocognitive evaluations on 192 trial participants that were randomized to differing chemotherapy regimens. Neurocognitive evaluations included assessment of intellectual functioning (IQ), working memory, and processing speed (PS) and were conducted 8-24 months after completion of therapy. The primary objective of the overall clinical trial was to determine whether mode of methotrexate delivery (high-dose vs. escalating dose) or type of steroid (prednisone vs. dexamethasone) provided superior overall survival and decreased relapse rates.

KEY FINDINGS:  Neither type of methotrexate delivery, nor type of steroid used was associated with a difference in neurocognitive outcomes.  Nevertheless, important information regarding host characteristics and their contribution to poor neurocognitive outcomes were identified.  First, survivors who were less than 10 years of age at diagnosis had significantly lower estimated IQ and PS scores.  In addition, study participants who were covered by U.S. public health insurance had significantly lower estimated IQ than those participants who were covered by private or military insurance.

WHAT THIS MEANS FOR CHILDHOOD CANCER SURVIVORS:  This week’s post is the third in a series in which the focus has been neurocognitive outcomes.  Once again, this study highlights the high potential for neurocognitive deficits, even in patients that received chemotherapy alone and independent of radiation exposure.  Moreover, this study is highly relevant because it evaluates neurocognitive outcomes in the context of contemporary childhood leukemia trials.  With few novel drugs available for childhood leukemia and overall excellent survival rates with the current standard of care, recent clinical trials have focused more on evaluating minor changes to existing regimens (changes to drug doses or interchanging drugs within a class).  A major aspect of these studies has also been focused on simultaneously evaluating survival and quality of life.  Since improving neurocognitive outcomes can have a dramatic positive impact on survivors’ overall life trajectory, laying the foundation in clinical trials to study the factors that impact these outcomes have become increasingly important.  This particular study highlights age of exposure and insurance status as important contributing factors to neurocognitive outcomes that need to be further evaluated.  The current COG high-risk B-ALL study is prospectively evaluating neurocognitive outcomes.  All survivors should maintain annual follow-up with oncology providers experienced in late health outcomes.  This will facilitate the research that is needed to provide a better understanding of neurocognitive outcomes for all survivors and position individual patients to obtain the most up-to-date care.



Medical Disclaimer:  The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only.  If you feel the research summarized applies to you or someone you know, talk to your doctor about your concerns.



Videos with Dr. Aune

Presentation on YouTube (Jan 2015):  Eliminating Long-term Health Effects in Cancer Survivors – Gregory Aune, MD, PhD

Interview for the National Coalition for Cancer Survivorship (June 2015):  Hodgkin’s Lymphoma Survivor Dr. Greg Aune Discusses Issues in Long-Term Survivorship Care

Interview with the Washington Post Live Summit (Dec 2016): How cancer lives on in young adults after treatment ends



Dr. Gregory J. Aune is the Stephanie Edlund Distinguished Professor of Pediatric Cancer Research and a St. Baldrick’s Foundation Scholar.  His experience in pediatric cancer spans over 27 years and encompasses his own patient experiences, research in experimental therapeutics, clinical care of pediatric oncology patients, and childhood cancer advocacy.  His interest in pediatric oncology began at age 16, when he was diagnosed with Hodgkin’s lymphoma.  While fortunate to survive, the experiences he encountered as a patient initiated a path towards a research and clinical career aimed at developing less toxic chemotherapy regimens.  His experience as a long-term survivor included open-heart surgery at age 35 to replace his aortic valve and bypass three blocked coronary arteries that were damaged by his teenage cancer therapies.  This life-changing event initiated his research interest in cardiac disease.  His training to become a successful physician scientist and pediatric oncologist has included time spent at some of the most well-respected oncology institutions in the United States including, M.D. Anderson Cancer Center, the National Cancer Institute, and Johns Hopkins Hospital.

Dr. Aune is a national leader in childhood cancer advocacy efforts.  In San Antonio, he has been a leader in local fundraising and awareness efforts.   Since 2010, he has spearheaded efforts by the St. Baldrick’s Foundation and For the Kids Dance Marathon at the University of Texas San Antonio that have raised over $830,000 for childhood cancer patients and research efforts.  In September 2014, his appointment to the National Cancer Institute Council of Research Advocates (NCRA) was announced by NCI Director Dr. Harold Varmus at a White House briefing on childhood cancer.

In addition, Dr. Aune is a policy advisor for the National Coalition for Cancer Survivorship, serves on the Board of Directors of the American Childhood Cancer Organization, is a member of the St. Baldrick’s Foundation National Advocacy Committee, and serves on the scientific advisory board for the Canines-N-Kids foundation.

In May 2015, Dr. Aune addressed the 68th World Health Assembly in Geneva, Switzerland and called on the World Health Organization to make childhood cancer a top global health priority.



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