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Cole PD, Finkelstein Y, Stevenson KE, Blonquist TM, Vijayanathan V, Silverman LB, Neuberg DS, Sallan SE, Robaey P, Waber DP. Polymorphisms in Genes Related to Oxidative Stress Are Associated With Inferior Cognitive Function After Therapy for Childhood Acute Lymphoblastic Leukemia. J Clin Oncol 2015; 33:2205-11. [PMID: 25987702 DOI: 10.1200/jco.2014.59.0273] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Survivors of childhood acute lymphoblastic leukemia (ALL) exhibit increased rates of neurocognitive deficits. This study was conducted to test whether interpatient variability in neurocognitive outcomes can be explained by polymorphisms in candidate genes conferring susceptibility to neurocognitive decline. METHODS Neurocognitive testing was conducted in 350 pediatric leukemia survivors, treated on Dana-Farber Cancer Institute ALL Consortium Protocols 95-01 or 00-01. Genomic DNA was isolated from bone marrow collected at remission. Candidate polymorphisms were selected on the basis of prior literature, targeting genes related to drug metabolism, oxidative damage, altered neurotransmission, neuroinflammation, and folate physiology. Single nucleotide polymorphisms were detected using either a customized multiplexed Sequenom MassARRAY assay or polymerase chain reaction-based allelic discrimination assays. Multivariable logistic regression models were used to estimate the effects of genotype on neurocognitive outcomes, adjusted for the effects of demographic and treatment variables. False-discovery rate correction was made for multiple hypothesis testing, indicated as a Q value. RESULTS Inferior cognitive or behavioral outcomes were associated with polymorphisms in three genes related to oxidative stress and/or neuroinflammation: NOS3 (IQ, Q = 0.008; Vocabulary Q = 0.011; Matrix Reasoning Q = 0.008), SLCO2A1 (IQ Q = 0.043; Digit Span Q = 0.006; Block Design Q = 0.076), and COMT (Behavioral Assessment System for Children-2 Attention Q = 0.080; and Hyperactivity Q = 0.084). Survivors homozygous for NOS3 894T, with at least one SLCO2A1 variant G allele or with at least one GSTP1 variant allele, had lower mean estimated IQ scores than those without these genotypes. CONCLUSION These data are consistent with the hypothesis that oxidative damage contributes to chemotherapy-associated neurocognitive decline among children with leukemia.
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Affiliation(s)
- Peter D Cole
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA.
| | - Yaron Finkelstein
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Kristen E Stevenson
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Traci M Blonquist
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Veena Vijayanathan
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Lewis B Silverman
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Donna S Neuberg
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Stephen E Sallan
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Philippe Robaey
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
| | - Deborah P Waber
- Peter D. Cole, Veena Vijayanathan, Albert Einstein College of Medicine, Bronx, NY; Yaron Finkelstein, Hospital for Sick Children, University of Toronto, Toronto; Philippe Robaey, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Kristen E. Stevenson, Traci M. Blonquist, Donna S. Neuberg, Dana-Farber Cancer Institute (DFCI); Lewis B. Silverman, Stephen E. Sallan, DFCI, Boston Children's Hospital, Harvard Medical School; and Deborah P. Waber, DFCI, Harvard Medical School, Boston, MA
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Castellino SM, Ullrich NJ, Whelen MJ, Lange BJ. Developing interventions for cancer-related cognitive dysfunction in childhood cancer survivors. J Natl Cancer Inst 2014; 106:dju186. [PMID: 25080574 DOI: 10.1093/jnci/dju186] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Survivors of childhood cancer frequently experience cancer-related cognitive dysfunction, commonly months to years after treatment for pediatric brain tumors, acute lymphoblastic leukemia (ALL), or tumors involving the head and neck. Risk factors for cancer-related cognitive dysfunction include young age at diagnosis, treatment with cranial irradiation, use of parenteral or intrathecal methotrexate, female sex, and pre-existing comorbidities. Limiting use and reducing doses and volume of cranial irradiation while intensifying chemotherapy have improved survival and reduced the severity of cognitive dysfunction, especially in leukemia. Nonetheless, problems in core functional domains of attention, processing speed, working memory and visual-motor integration continue to compromise quality of life and performance. We review the epidemiology, pathophysiology and assessment of cancer-related cognitive dysfunction, the impact of treatment changes for prevention, and the broad strategies for educational and pharmacological interventions to remediate established cognitive dysfunction following childhood cancer. The increased years of life saved after childhood cancer warrants continued study toward the prevention and remediation of cancer-related cognitive dysfunction, using uniform assessments anchored in functional outcomes.
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Affiliation(s)
- Sharon M Castellino
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL).
| | - Nicole J Ullrich
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Megan J Whelen
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
| | - Beverly J Lange
- Department of Pediatrics, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC (SMC); Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC (SMC, MJW); Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA (NJU); Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (BJL)
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