Acute lymphoblastic leukemia (ALL) stands as the most prevalent form of pediatric cancer in North America, with a current five-year survival rate of 85%. While more children achieved ALL remission and transition into adulthood, the prevalence of long-term treatment-related effects, especially neurocognitive sequelae, remains significant. This study pursues two objectives. Firstly, it investigates if Magnetization Transfer Ratio (MTR), a method assessing myelin integrity, is sensitive to white matter (WM) microstructural changes in long-term ALL survivors and whether these relate to cognitive impairments. Secondly, it examines the dose-related effects of chemotherapy agents on the MTR and its relationship to other risk factors such as female sex, early age diagnosis, and cranial radiotherapy. Magnetization transfer imaging was utilized to assess WM integrity in 35 survivors at a mean of 18.9 years after the onset of ALL (range since diagnosis: 6.9–26.8). Additionally, 21 controls matched for age, sex, and education level, with no history of cancer, were included. MTR was extracted from both the entire brain’s WM and the corpus callosum through semi-automated procedures. The results indicated lower MTR means in survivors, which is linked to cognitive function. Negative associations between MTR means and intrathecal agents’ (MTX, cytarabine, and hydrocortisone) cumulative doses received were highlighted. This study offers valuable insights into the connections between myelin deterioration, cognitive impairment, and the implications of IT chemotherapy, enhancing our understanding of ALL survivorship dynamics. It underscores MTR’s relevance in monitoring neurotoxicity during oncological drug follow-up examinations.
急性淋巴细胞白血病是北美地区最常见的儿童癌症，当前五年生存率达85%。随着更多患儿实现疾病缓解并进入成年期，治疗相关的长期影响——特别是神经认知后遗症的普遍性依然显著。本研究旨在实现两个目标：首先，探究评估髓鞘完整性的磁化传递率技术是否对长期ALL幸存者的白质微结构变化具有敏感性，以及这些变化是否与认知功能障碍相关；其次，考察化疗药物剂量对磁化传递率的影响及其与女性性别、早期诊断年龄、颅脑放射治疗等其他风险因素的关联性。研究采用磁化传递成像技术评估35名平均确诊后18.9年（确诊时间跨度：6.9-26.8年）的ALL幸存者的白质完整性，同时纳入21名在年龄、性别和教育水平相匹配且无癌症病史的对照组。通过半自动程序提取全脑白质及胼胝体的磁化传递率数值。结果显示幸存者组的磁化传递率均值较低，且与认知功能存在关联。研究特别发现磁化传递率均值与鞘内注射药物（甲氨蝶呤、阿糖胞苷和氢化可的松）的累积剂量呈负相关。本研究为理解髓鞘退化、认知障碍与鞘内化疗影响之间的关联提供了重要见解，深化了我们对ALL幸存者动态变化的认识，并凸显了磁化传递率在肿瘤药物随访监测神经毒性中的临床应用价值。
肿瘤(癌症)患者之家