Acute lymphoblastic leukemia (ALL)
ALL is the most common childhood malignancy; survival rates exceed
90%.21,22 Treatment modifications have substantially
reduced neurocognitive late effects, but survivors continue to
demonstrate neurocognitive impairments secondary to disease and
treatment that impacts educational/occupational
outcomes.23
COG AALL1731 for children with newly diagnosed NCI standard-risk B-ALL,
including children with Down syndrome and ALL (DS-ALL) examines whether
treatment with blinatumomab in combination with chemotherapy lowers the
risk for relapse and increases survival. AALL1731 includes embedded
neurocognitive studies that will lay the groundwork for future
risk-based neurocognitive screening and targeted interventions to
improve survivors’ QOL.
Recognizing the importance of the relationship between neurocognition
and poverty,24 AALL1731 includes the first
comprehensive investigation of poverty-related neurocognitive outcome
disparities in pediatric standard risk B-ALL. This embedded study
explores whether children living in poverty (defined as presence of
household material hardship – food, housing, or energy insecurity) at
the time of diagnosis, are at risk for greater neurocognitive declines
from baseline measured via Cogstate than their less impoverished
counterparts. Additionally, among a subset of children enrolled in the
household material hardship neurocognitive study, there is an aim
investigating the impact of blinatumomab on caregiver burden and PROs.
Finally, AALL1731 includes the first prospective study of neurocognitive
outcomes in children with DS-ALL. Despite increased vulnerability to
leukemia25,26 and treatment
toxicities,27,28 these patients have been
systematically excluded from decades of neurocognitive studies in
childhood ALL23 and thus very little is known about
their neurocognitive outcomes. The DS-ALL neurocognitive study
investigates individual, clinical, and socioenvironmental determinants
of neurocognitive and QOL outcomes. Findings will drive the future
inclusion of individuals with DS-ALL in evidence-based clinical practice
guidelines for neurocognitive screening, survivorship care, and
interventions.