The Longitudinal Parallel Process Analysis of Biomarkers of Oxidative Stress, Symptom Clusters, and Cognitive Function in Children With Leukemia.

Journal Article (Journal Article)

Background: During treatment for acute lymphoblastic leukemia (ALL), children report co-occurring symptoms of fatigue, sleep disturbance, pain, nausea, and depression as a symptom cluster. Central nervous system-directed ALL therapies also put children at risk for cognitive impairments. Cancer therapies can cause an increase in oxidative stress, which may contribute to treatment-related symptoms. This study examined the longitudinal relationships between biomarkers of oxidative stress in the cerebrospinal fluid, the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L), and cognition, in children over the first year of ALL treatment. Methods: Glutathione (GSH) biomarkers of oxidative stress were measured in cerebrospinal fluid collected during treatment lumbar punctures. GSH biomarkers, symptoms, and cognitive function of 132 children aged 3 to 18 years were evaluated at four time points during the first year of leukemia treatment. Participants, 7 years and older, completed self-report measures, and parents reported for younger children. Cognitive function measurements for all participants were completed by parents. A longitudinal parallel-process model was used to explore the influence of the initial measurement and the subsequent change over four time points of the GSH biomarkers on the CCSC-L and cognition. Results: GSH biomarkers increased over the four time points indicating decreasing oxidative stress. When GSH biomarkers were higher (less oxidative stress) at the initial measurement, the CCSC-L severity was lower, cognition was better, and cognition improved over the four measurements. Screening children for high levels of oxidative stress would be a foundation for future intervention studies to address symptom distress and cognitive impairments.

Full Text

Duke Authors

Cited Authors

  • Hooke, MC; Hatch, D; Hockenberry, MJ; Whitman, S; Moore, I; Montgomery, D; Marano, K; Mitby, P; Scheurer, ME; Taylor, O; Pan, W

Published Date

  • July 2020

Published In

Volume / Issue

  • 37 / 4

Start / End Page

  • 244 - 254

PubMed ID

  • 32141369

Pubmed Central ID

  • PMC7312345

Electronic International Standard Serial Number (EISSN)

  • 1532-8457

International Standard Serial Number (ISSN)

  • 1043-4542

Digital Object Identifier (DOI)

  • 10.1177/1043454220909785


  • eng