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Brain Function in Young Patients Receiving Methotrexate for Acute Lymphoblastic Leukemia

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ClinicalTrials.gov Identifier: NCT00437060
Recruitment Status : Completed
First Posted : February 19, 2007
Last Update Posted : July 21, 2017
Sponsor:
Collaborator:
Information provided by (Responsible Party):

Study Description
Brief Summary:
This clinical trial is looking at brain function in young patients receiving methotrexate for acute lymphoblastic leukemia. Learning about the long-term effects of methotrexate on brain function may help doctors plan cancer treatment.

Condition or disease Intervention/treatment
Childhood B Acute Lymphoblastic Leukemia Childhood T Acute Lymphoblastic Leukemia Cognitive Side Effects of Cancer Therapy Long-Term Effects Secondary to Cancer Therapy in Children Neurotoxicity Syndrome Psychological Impact of Cancer Untreated Childhood Acute Lymphoblastic Leukemia Procedure: Cognitive Assessment Procedure: Diffusion Tensor Imaging Other: Laboratory Biomarker Analysis Other: Pharmacological Study Procedure: Psychosocial Assessment and Care

Detailed Description:

OBJECTIVES:

I. Determine the neuropsychological function in children with acute lymphoblastic leukemia treated with either high-dose methotrexate or escalating-dose methotrexate in the absence of cranial radiation and nelarabine.

II. Identify host polymorphisms that predict an increased risk of neurocognitive dysfunction or acute neurotoxicity in these patients.

III. Correlate neuropsychological outcome measures and the occurrence of acute neurotoxicity with host polymorphisms in these patients.

IV. Measure concentrations of 5-methyltetrahydrofolate, homocysteine, Ado, S-adenosylmethionine, S-adenosylhomocysteine, and other potentially relevant compounds in serum and cerebrospinal fluid during interim maintenance therapy with low- or high-dose methotrexate regimens, respectively, and correlate these endpoints with the occurrence of acute neurologic toxicity and long-term neurocognitive dysfunction in these patients.

V. Determine whether or not diffusion tensor imaging will identify areas of selective vulnerability in CNS and provide an imaging modality that predicts and/or correlates with neuropsychological outcome.

OUTLINE: This is a prospective, cohort, multicenter study.

Patients complete neurocognitive tests to assess thinking, memory, attention, and concentration. The baseline test is administered during the consolidation phase of chemotherapy and further tests are done at 1 year from baseline and 1 year after* the completion of study therapy.

Patients undergo blood and cerebrospinal fluid collection periodically for biomarker, genotypic polymorphisms, and pharmacokinetic analysis. Patients undergo MRI diffusion-tensor imaging to correlate imaging with neuropsychological outcomes.

NOTE: * Within 8 months to 24 months after the completion of study therapy for patients on AALL0232.


Study Design

Study Type : Observational
Actual Enrollment : 233 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: A Study of Neurocognitive Function in Children Treated for ALL
Study Start Date : January 2007
Primary Completion Date : September 2015


Groups and Cohorts

Group/Cohort Intervention/treatment
Ancillary/Correlative (neurocognitive assessment, biomarkers))

Patients complete neurocognitive tests to assess thinking, memory, attention, and concentration. The baseline test is administered during the consolidation phase of chemotherapy and further tests are done at 1 year from baseline and 1 year after* the completion of study therapy.

Patients undergo blood and cerebrospinal fluid collection periodically for biomarker, genotypic polymorphisms, and pharmacokinetic analysis. Patients undergo MRI diffusion-tensor imaging to correlate imaging with neuropsychological outcomes.

Procedure: Cognitive Assessment
Ancillary studies
Procedure: Diffusion Tensor Imaging
Correlative studies
Other Name: DTI
Other: Laboratory Biomarker Analysis
Correlative studies
Other: Pharmacological Study
Correlative studies
Procedure: Psychosocial Assessment and Care
Ancillary studies
Other Names:
  • Psychosocial Assessment
  • Psychosocial Care
  • Psychosocial Care/Assessment
  • Psychosocial Studies
  • Psychosocial Support


Outcome Measures

Primary Outcome Measures :
  1. Change in neurocognitive function by the Pediatric Quality of Life (PedQL) battery, Full Scale Intelligence Quotient (FSIQ) score [ Time Frame: From baseline to up to 24 months ]
    Vocabulary and Block Design, subtests of the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), Wechsler Children Intelligence Scale (WISC-IV) and Wechsler Adult Intelligence Scale (WAIS-III) (based on age) will be used to estimate FSIQ, using the tables provided by Sattler.

  2. Polymorphisms as predictors of neurocognitive dysfunction or acute neurotoxicity [ Time Frame: Up to 24 months ]

Secondary Outcome Measures :
  1. Correlation between neuropsychological outcomes and acute neurotoxicity [ Time Frame: Up to 24 months ]

Biospecimen Retention:   Samples Without DNA
blood and cerebrospinal fluid

Eligibility Criteria

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Ages Eligible for Study:   1 Year to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients with newly diagnosed acute lymphoblastic leukemia meeting other criteria.
Criteria

Inclusion Criteria:

  • Diagnosis of acute lymphoblastic leukemia
  • Enrolled on COG-AALL0434 (Cohort #1 only) or COG-AALL0232 (Cohorts #1 and #2)

    • Patients must have received either high-dose methotrexate or escalating-dose methotrexate during interim maintenance.
  • No CNS-3 disease
  • Patients must enroll within 8-24 months after completion of therapy on COG-AALL0232 and no evidence of relapsed or secondary malignancy
  • No known significant neurodevelopmental disability unrelated to cancer diagnosis including, but not limited to, any of the following:

    • Down syndrome
    • Fragile X mental retardation
    • Autism
    • Pervasive developmental disability
    • Seizure disorder
  • Attention-deficit hyperactivity disorder or specific learning disability (e.g., dyslexia) allowed
  • No sensory impairment (e.g., pre-existing uncorrectable vision impairment or deafness)
  • No cranial radiation therapy
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00437060


  Show 112 Study Locations
Sponsors and Collaborators
Children's Oncology Group
National Cancer Institute (NCI)
Investigators
Principal Investigator: Naomi Winick Children's Oncology Group
More Information

Responsible Party: Children's Oncology Group
ClinicalTrials.gov Identifier: NCT00437060     History of Changes
Other Study ID Numbers: AALL06N1
NCI-2009-00315 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
CDR0000528920
AALL06N1 ( Other Identifier: Childrens Oncology Group )
AALL06N1 ( Other Identifier: CTEP )
U10CA098543 ( U.S. NIH Grant/Contract )
First Posted: February 19, 2007    Key Record Dates
Last Update Posted: July 21, 2017
Last Verified: July 2017

Additional relevant MeSH terms:
Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Neurotoxicity Syndromes
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Nervous System Diseases
Poisoning
Chemically-Induced Disorders