Longitudinal Trajectories of Neurocognitive Functioning in Childhood Acute Lymphoblastic Leukemia

Marita Partanen, Sean Phipps, Kathryn Russell, Doralina L Anghelescu, Joshua Wolf, Heather M Conklin, Kevin R Krull, Hiroto Inaba, Ching-Hon Pui, Lisa M Jacola

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Children with acute lymphoblastic leukemia (ALL) are at risk for neurocognitive deficits, and examining individual variability is essential to understand these risks. This study evaluated latent longitudinal trajectories and risk factors of neurocognitive outcomes in childhood ALL.

METHODS: There were 233 participants with ALL who were enrolled on a phase 3, risk-stratified chemotherapy-only clinical trial (NCT00137111) and who completed protocol-directed neurocognitive assessments [47.6% female, mean (SD) = 6.6 (3.7) years]. Measures of sustained attention, learning/memory, and parent ratings of attention were completed during and after treatment. Longitudinal latent class analyses were used to classify participants into distinct trajectories. Logistic regression was used to identify predictors of class membership.

RESULTS: Within the overall group, attention performance was below age expectations across time (Conners Continuous Performance Test detectability/variability, p < 0.01); memory performance and parent ratings were below expectations at later phases (California Verbal Learning Test learning slope, p < 0.05; Conners Parent Rating Scale, Revised attention/learning, p < 0.05). Most participants (80-89%) had stable neurocognitive profiles; smaller groups showed declining (3-6%) or improving (3-11%) trajectories. Older age (p = 0.020), female sex (p = 0.018), and experiencing sepsis (p = 0.047) were associated with greater attention problems over time. Lower baseline IQ was associated with improved memory (p = 0.035) and fewer ratings of attention problems (p = 0.013) over time.

CONCLUSIONS: Most patients with ALL have stable neurocognitive profiles. Smaller groups have significant impairments shortly after diagnosis or have worsening performance over time. A tiered assessment approach, which includes consideration of individual and clinical risk factors, may be useful for monitoring neurocognitive functioning during treatment and survivorship.

Original languageEnglish
Pages (from-to)168-178
Number of pages11
JournalJournal of pediatric psychology
Issue number2
Publication statusPublished - 19 Feb 2021


  • Aged
  • Child
  • Cognition
  • Cognition Disorders
  • Female
  • Humans
  • Learning
  • Male
  • Memory
  • Neuropsychological Tests
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy


Dive into the research topics of 'Longitudinal Trajectories of Neurocognitive Functioning in Childhood Acute Lymphoblastic Leukemia'. Together they form a unique fingerprint.

Cite this