Twenty-three leukemic children were studied prospectively to detect chronic effects of therapy. All patients received CNS prophylaxis, including 2400 R cranial irradiation, and intermittent maintenance therapy with intravenous methotrexate, cyclophosphamide and cytosine arabinoside. Neurologic symptoms were observed in 12 patients, all of whom had intermittent limping and milt! incoordination, between the 10th and 18th month of maintenance therapy. Five of the 12 sustained seizures and four of these had subsequent abnormalities in motor, perceptual, behavioral or language developnent. Three school-aged children have learning disability and perceptual-motor defects. Studies of CSF folate a n d M T X content are presented but are not helpful i n delineating the etiology of these neurologic symptoms.
Cancer 372353457, 1976.
ECENT IMPROVEMENTS IN THERAPY FOR
R acute lymphoblastic leukemia of childhood have resulted in increasing survival for many patients.1."7 Chronic effects of either the underlying disease or its therapy are becoming apparent and may assume increasing significance with long-term disease con trol.ll~lz This report describes a spectrum of neurologic abnormalities observed during a prospective study of 23 leukemic children, 2 to 15 years of age, which appears to be a result of therapy.
MATERIALS A N D METHODS
Twenty-three children with acute lymphoblastic or undifferentiated leukemia who had maintained initial complete remission for at least 12 months were studied prospectively for effects <of therapy on neurological function.