Early and late complications

Neurotoxicity in acute lymphoblastic leukemia (ALL)
Harila Saari, Christoforaki, et al.
Severe early CNS side-effects are common during ALL treatment and may lead to later epilepsy and cognitive problems. Incidence and mechanisms for these side-effects are studied within the upcoming ALL treatment protocol, ALLTogether, where cerebrospinal fluid samples are collected to study predictive biomarkers for CNS side-effects, and these effects are also studied in an international registry with more than 1400 children with ALL and neurotoxicity.

Skeletal side effects in ALL
Harila Saari, Giertz, et al.
Bone necrosis is found in about 7% of patients with ALL. There is today no evidence based treatment. We study the development of bone necrosis within the upcoming ALL treatment protocol, ALLTogether and whether early treatment with bisphosphonates can stop progression of bone necrosis and the development of arthrosis. Late-effects and quality of life after bone necrosis are studied and the predictive value of a new radiological classification system is analyzed.

Metabolic and immunological late effects of chemotherapy in high-risk and infant ALL patients
Harila-Saari, Bergstein, Lähteenmäki et al.
The NOPHO ALL2008 protocol high-risk chemotherapy treatment has been exceptionally intensive. We study metabolic consequences and immunity after this treatment. We also study genetic markers for early aging in these patients; telomere length and DNA methylation age. Sideeffects, especially prevalence of infections, are studied in the unusually intensive Infant ALL2014 protocol.

Late cognitive effects after CNS radiotherapy in children with cancer
Harila Saari, Ehrstedt, Lahne, Sjöström, et al.
We compare neurological and hormonal changes following proton- and photon radiation therapy with special focus on secondary brain tumors, vascular changes and changes in the white matter of the brain, and their association with cognitive function and quality of life. We analyze telomere length and DNA methylation age (biological clock) to investigate how irradiation therapy impacts the body’s aging processes.

Glioneuronal tumors in children and adolescents
Ehrstedt et al.
Glioneuronal tumors are low-grade brain tumors which often give rise to a focal epilepsy, which in many cases risks becoming resistant to therapy. Epilepsy surgery with lesionectomy can in many cases be a curative treatment. Prognostic factors for long-term seizure freedom, cognition, and quality of life as well as late effects will be evaluated.

Motor skills and balance after treatment of pilocytic astrocytomas in the posterior cranial cavity in childhood
Kristiansen et al.
Results from completed studies concerning children and adolescents and young adults who were treated for pilocytic astrocytomas in the posterior cranial cavity, showed that a third of the patients examined had difficulties with learning and motor skills, especially fine motor skills and balance. When dynamic balance was examined with the Mini Balance Evaluation Systems Test (Mini-BESTest), patients had significantly worse results compared with controls (p = 0.036). We are now planning further studies regarding motor skills and balance, where results on Dual-task tasks and from motion analyses will be evaluated. The aim is to gain a more in-depth understanding of patients' motor difficulties, which can lead to targeted recommendations for physical exercise.