Neuropsychological and academic characterization aspects among childreen and teenagers survivors of acute lymphoid leukemia (ALL) condition.
acute lymphoplastic leucemia, neuropsychology, neurodevelopment, pediatric oncology, learning.
Acute lymphoblastic leukemia (ALL) is the most common type of cancer among children and adolescents, which corresponds to one third of all pediatric neoplasms around the world. The refinement of diagnostic and therapeutic processes has promoted the increase of survivorship and the reduction of disease relapses on childhood. The inclusion of the CNS-directed prophylactic treatment in contemporary protocols has been pointed as an essential tool for therapeutic success, since this strategy promoted a reduction of disease relapses from 75% to 5%, which is directly related to the largest mortality rates among patients. CNS prophylaxis is commonly carried out through intrathecal chemotherapy associated with systemic chemotherapy during the standard treatment, and has been frequently related not only to the high cure rates, but also to the emergency of late neuropsychological effects, which incidence varies from 20% to 40% in childhood survivors of ALL. Studies on this field suggest that attention and executive functions domains seem to be more susceptible to CNS prophylactic chemotherapy, which in turn contribute to the global declines on intellectual and academic abilities experienced by this clinic group. In this context, neuropsychology contributions are highlighted in as much as it enables the screening of the preserved cognitive domains and move forward the investigation of the impacts related to the disease and its treatment on learning processes, behavior and daily living activities of survivors, considering the intersection between the treatment and CNS structure and functioning. In this perspective, the general purpose of this research project is to characterize the neuropsychological and academic aspects in childhood survivors of ALL. This proposal is justified by the lack of Brazilian data, especially of the Northeast, which make clear the effects related to the disease and the therapeutic protocols used in Brazil. Additionally, the need to better understand the nature, the extension and the underlying mechanisms to the neuropsychological and academic damage in this clinical population, given the controversies commonly found in studies of this thematic. 52 children and adolescents aged 6-16 years-old were enrolled in the study and were divided into two groups: G1) Children and adolescents diagnosed with ALL treated exclusively with chemotherapy; G2) Healthy children and adolescents with no history of neurologic or psychiatric dysfunctions which integrated a control group matched according to the patients’ social and demographic characteristics like sex, age, socioeconomic level and type of school. The protocol of neuropsychological evaluation used in this study covers the following domains: intellectual abilities, attention, memory, visual-spatial abilities, executive functions, academic abilities and behavioral aspects. Data is being analyzed through descriptive and inferential statistical tools, notably through non-parametric tests and multivariate descriptive cluster analysis, with the aim of grouping the information contained in descriptive and categorical variables. The outcomes of these analysis lead to an organization of results arising from the discussion of three key topics: 1) Characterization of intellectual abilities of childhood ALL survivors; 2) Attention and executive functions in childhood ALL survivors; 3) Academic aspects in children and adolescents ALL survivors. Finally, it is expected that the development of this study may better characterize the neuropsychological changes related to the prophylactic treatment on childhood. Additionally, it is intended to produce relevant knowledge in the field of developmental and learning neuropsychology and its intersection with pediatric oncology, in order to subside the creation of intervention strategies towards the comprehension, minimization and/or prevention of late effects experienced by this population and contribute to the research efforts aimed to achieve the delicate balance between the therapeutic effectiveness, the maintenance of minimal levels of toxicity and survivors quality of life.