Cognitive and Academic Sequele in Bangladeshi Children with Acute Lymphoblastic Leukemia Treated With Long-Term Chemotherapeutic Agents

Author Details : Md Golam Hafiz, Chowdhury Yakub Jamal

Volume : 1, Issue : 1, Year : 2015

Article Page : 24-36

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 The survival rate of childhood acute lymphoblastic leukemia (ALL) is about 90 percent; new research is emerging of its late effects. Literature reviewed investigating the relationship of treatment protocol of ALL too specific late effects, underlying mechanisms and possible remedy.
2,750 diagnosed children of ALL with age of 1-15 years were included in this retrospective study. Literature was surveyed the occurrence and topography of late effects (cognitive and intellectual). The patients had completed the child symptom inventory (CSI) to rate their child’s academic performance on a 4-point Likert scale (1=falling, 2=below average, 3=average, 4=above average). Literature was reviewed to find out the underlying mechanisms of these deficits and possible remedy. Here, mice were used as models to answer these questions for assessment of treatment of children with ALL.
Male female ratio was 1.4:1. Based on CSI, 31.81% had below average, 45.27% average and 22.90% above average behavioral and academic performance. Early chemotherapy induced academic and learning deficit was found 34.43%, late 43.48% and no sequelae 22.07%. Early radiation induced cognitive impairment was 23.08% and late 35.52% and had no deficits 41.38%. Neuropsychological impairment was found 24.42% in early phase and 34.9% in late and 40.72% found without any impairment. Chemotherapy induced cognitive impairment at early phase were 38.65%, late 20.39% and 40.94% had no deficits. Male preponderance of these deficits were found both early and late phase of treatment. Childhood leukemia exhibit cognitive and academic deficits and should be placed in a special education program. Behavioral evidence has highlighted impairments in areas of attention, working memory and processing speed leading to decrease in intelligent quotient (IQ). Neurophysiological evidence in ALL has impact abnormalities on white matter and acquired brain damage resulting from chemotherapy.
The exact role of chemotherapeutic agents causing cognitive and academic sequelae is still unknown. The deficits are more pronounced in male at early phase of treatment may be due to increased acceptance of chemotherapeutic agents. Female are affected less may be due to their genetic factors. Cognitive and academic impairment are common following chemotherapy. Radiation also causes cognitive deficits in children with ALL. Neuropsychological impairment was also a feature following chemotherapy in ALL. Improved mice model of cognitive and learning deficits are recommended in survivors of childhood ALL with suggestions for future directions in this field in hopes that ensuing treatment regimens will further reduce or eliminate these deficits in future.

Key words: Cognitive and academic sequelae; Acute lymphoblastic leukemia; Chemotherapeutic agents
Abbreviations: ALL=acute lymphoblastic leukemia; CSI=child symptom inventory; IQ=intelligent quotient


How to cite : Hafiz M G, Jamal C Y, Cognitive and Academic Sequele in Bangladeshi Children with Acute Lymphoblastic Leukemia Treated With Long-Term Chemotherapeutic Agents. IP Int J Med Paediatr Oncol 2015;1(1):24-36

Copyright © 2015 by author(s) and IP Int J Med Paediatr Oncol. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (

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