Long-term leukoencephalopathy and neurocognitive functioning in childhood sarcoma patients treated with high-dose intravenous chemotherapy

Charlotte Sleurs, Jurgen Lemiere, Ahmed Radwan, Marjolein Verly, Iris Elens, Marleen Renard, Sandra Jacobs, Stefan Sunaert, Sabine Deprez, Anne Uyttebroeck

Research output: Contribution to journalArticleScientificpeer-review


PURPOSE: Knowledge is limited regarding the prevalence and persistence of chemotherapy-induced leukoencephalopathy in childhood sarcoma patients. This study explored the presence, clinical relevance, and potential risk factors of leukoencephalopathy in childhood bone and soft tissue sarcoma survivors, treated with intravenous chemotherapy.

METHODS: We acquired cross-sectional neurocognitive data in adult survivors (n = 34) (median age at diagnosis [AaD] = 13.32 years, age range = 16-35 years) and healthy age-matched controls (n = 34). Additionally, magnetic resonance imaging included T2-weighted FLAIR (leukoencephalopathy Fazekas rating), multiexponential T2 relaxation (MET2), and multishell diffusion MRI to estimate myelin integrity-related metrics and fluid movement restrictions. Finally, chemotherapy subgroups (methotrexate, alkylating agents, or combination), AaD, and Apoε and MTHFRC677T polymorphisms were explored as potential risk factors for leukoencephalopathy.

RESULTS: At the group level, quality of life, working memory, processing speed, and visual memory were significantly lower in patients compared to controls. Furthermore, long-term leukoencephalopathy was observed in 27.2% of the childhood sarcoma survivors, which was related to attentional processing speed. Lesions were related to diffusion-derived, but not to myelin-sensitive metrics. A significant interaction effect between AaD and chemotherapy group demonstrated more lesions in case of high-dose methotrexate (HD-MTX) (F = 3.434, P = .047). However, patients treated with alkylating agents (without HD-MTX) also showed lesions in younger patients. Genetic predictors were nonsignificant.

CONCLUSION AND IMPLICATION: This study suggests long-term leukoencephalopathy with possibly underlying changes in vasculature, inflammation, or axonal injury, but not necessarily long-term demyelination. Such lesions could affect processing speed, and as such long-term daily life functioning of these patients.

Original languageEnglish
Pages (from-to)e27893
JournalPediatric Blood & Cancer
Issue number10
Publication statusPublished - 2019
Externally publishedYes


  • Administration, Intravenous
  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols/administration & dosage
  • Cancer Survivors
  • Cognition Disorders/chemically induced
  • Cross-Sectional Studies
  • Female
  • Humans
  • Leukoencephalopathies/chemically induced
  • Male
  • Sarcoma/drug therapy
  • Young Adult


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