Introduction: Subtle neurocognitive deficits have been recently observed in Acute
Lymphoblastic Leukemia (ALL) survivors.
Aim: We aim to assess the neurocognitive functions of ALL survivors who had been treated with
chemotherapy only using two different protocols, and to identify treatment-related risk factors.
Patients and Methods: We carried a multicenter study involving 3 pediatric oncology centers on
100 children who were treated for ALL. Fifty patients were treated by the modified Children’s
Cancer Group (CCG) 1991 protocol with low dose methotrexate and 50 children were treated by
Total XV protocol with high dose methotrexate. Fifty healthy children were included as a control
group. Psychometric assessment using Arabic version of Wechsler intelligence scale for children
(WISC III) was performed for all patients and controls.
Results: Patients had significantly lower mean full scale IQ, performance IQ and verbal IQ than
controls. Patients 5 years at diagnosis had significantly lower mean full scale IQ and performance
IQ than patients>5 years at diagnosis, while the verbal IQ showed no significant difference between
both age groups. Female patients had significantly lower mean full scale IQ, performance IQ and
verbal IQthan males. Patients who received Total XV protocol with high dose methotrexate had
significantly lower mean full scale IQ, performance IQ and verbal IQ than patients who received
modified CCG 1991 protocol with low dose methotrexate.
Conclusions: CNS directed chemotherapy might appear to affect neurocognitive functions in children
with ALL, which is more significant in young children at diagnosis, in girls and in those receiving
high dose methotrexate.