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.