Long-term adverse neuropsychologic sequelae are frequently observed in pediatric patients treated for acute lymphoblastic leukemia(ALL). In this study, 10 children in continuous com- plete remission from ALL were given tests of IQ, neuropsychologic assessment, waking EEG, brain MRI to assess neuropsychologic functioning minimum 2 years after CNS prophylaxis. All children were free of CNS disease at diagnosis and had received CNS prophylactic treatment with 1,800 cGy cranial irradiation plus intrathecal methotrexate. Male patients had a significant decline in coding compared with female patients(P<0.01) and those evaluated beyond age of 10-year-old had a greater decline in performance IQ compared with those evaluated under age of 10-year-old(P<0.01). One of the 10 children(10%) showed white matter changes on MRI attributable to therapy. All children had no significant lower mean IQ, but lower achievement with regard to arithmetic skills, picture arrangement than other tests. We conclude that prophylactic CNS therapy may cause cognitive dysfunctions and the white matter changes but its value and significance during follow-up should be assessed in well designed longitudinal research studies.
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