Diminished Quality of Life Despite Reduced Treatment in Children With B-Lymphoblastic Leukemia: Children's Oncology Group AALL0932

Lyn M. Balsamo, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
John A. Kairalla, Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida, USA.
Emily Hibbitts, Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, Florida, USA.
Rozalyn L. Rodwin, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Meenakshi Devidas, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Alexandra Dreyzin, Pediatric Oncology Branch, National Cancer Institute and Center for Cellular Engineering, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Naomi J. Winick, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
William L. Carroll, Perlmutter Cancer Center and Department of Pediatrics, NYU Langone Medical Center, New York, New York, USA.
Stephen P. Hunger, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Elizabeth A. Raetz, Perlmutter Cancer Center and Department of Pediatrics, NYU Langone Medical Center, New York, New York, USA.
Reuven J. Schore, Pediatric Oncology Branch, National Cancer Institute and Center for Cellular Engineering, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Mignon L. Loh, Ben Towne Center for Childhood Cancer Research, Seattle Children's Hospital, Seattle, Washington, USA.
Kirsten K. Ness, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Anne L. Angiolillo, Servier Pharmaceuticals, Boston, Massachusetts, USA.
Nina S. Kadan-Lottick, Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

1-5-2026

Journal

Pediatric blood & cancer

DOI

10.1002/1545-5017.70029

Keywords

leukemia; oncology; pediatric; quality of life; treatment burden

Abstract

BACKGROUND: Quality of life (QOL) is impacted in children treated for leukemia. AALL0932 randomized reduction in vincristine/dexamethasone (VCR/DEX) pulses every 4 versus 12 weeks during maintenance in the average-risk subset of NCI standard risk B-ALL (NCI-SR AR B-ALL). We longitudinally assessed physical and emotional QOL, behavioral health, and school services by randomization. PROCEDURE: NCI-SR AR B-ALL English-speaking patients aged ≥4 years were evaluated at T1-T5 (∼2, 9, 18, 26 months [females treatment end], and 38 [males only] months from diagnosis) with parent-report. The Pediatric Quality of Life Inventory-4.0 and school services survey were administered longitudinally, and the Behavior Assessment Scale for Children-2 at therapy end. RESULTS: Data were obtained from 420 consented and randomized participants (mean 6.0±1.6 years, 45.7% female). Impairment among randomized participants at T2 and T4, respectively, was 11.3% and 12.5% for physical, and 12.2% and 9.8% for emotional function. In longitudinal models adjusting for race/ethnicity, time, and baseline impairment, pulse frequency was not associated with impairment (physical odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.5-1.8; emotional OR = 0.9, 95% CI = 0.5-1.7). T2 impairment was associated with increased risk of post-randomization impairment for physical (OR = 4.3, 95% CI: 1.9-9.9) and emotional (OR = 4.9, CI: 2.3-10.5) function. Approximately 73.8% reported one or more school-based service during treatment: special education/accommodations (67.6%) and physical/occupational therapy (8.8%). Depression (20%) and anxiety (19%) did not differ by pulse frequency. DISCUSSION: Children with NCI-SR AR B-ALL experience diminished QOL, despite reduced frequency of VCR/DEX maintenance pulses. Impairment begins early during ALL therapy and persists; interventions should commence early and continue throughout and after therapy.

Department

Pediatrics

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