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

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.