BRAIN PERFUSION AFTER TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA

Children with acute lymphoblastic leukemia (ALL) have impairment in th eir neuropsychological functioning and morphological changes in their brain after cranial irradiation and chemotherapy. The aim of this stud y was to identify possible brain perfusion defects caused by different types of treatment and their association with abnormalities in cerebr al MRI and neuropsychological and clinical neurological findings, Meth ods: Twenty-five consecutive children with ALL at the cessation of che motherapy or after 1 yr were included. All of the children were given intravenous and intrathecal methotrexate for central nervous system th erapy, 13 of them received cranial radiation therapy, Brain SPECT, cer ebral MRI, clinical neurological and neuropsychological evaluations we re performed, Results: Eleven of the 25 patients (44%) had brain perfu sion defects in SPECT, eight of whom were treated with chemotherapy al one, and three received cranial irradiation, Two patients had small bi lateral white matter changes on MRI; their brain SPECT scans were abno rmal, although the findings were not related. Impairment of neuropsych ological functioning was found in 86% of the patients tested, No signi ficant difference between the patients with abnormal and normal SPECT were found, Those patients with abnormal SPECT were younger than those with normal SPECT and had received more frequent intravenous methotre xate infusions, Conclusion: Brain SPECT detected perfusion defects tha t had occurred after treatment for childhood ALL. These defects may be related to frequent administration of a combination of intravenous an d intrathecal methotrexate and/or young age.