I would like to congratulate Hardy et al¹ on their report in Journal of Clinical Oncology analyzing the dangers of neurocognitive functioning in children with high-risk acute lymphoblastic leukemia (ALL) treated on the AALL0213 protocol. This report complements the neurotoxicity data provided in the article by Larsen et al,² which discussed only seizures and strokes. Hardy et al report that increasing leucovorin (folinic acid) rescue reduced the frequency of toxicity after lower doses of methotrexate (MTX) and that early high-dose leucovorin after MTX 33.6 gm/m² resulted in little acute or chronic neurotoxicity; however, the authors did not suggest an explanation for why they found no significant difference in neurocognitive outcome among patients who received high-dose MTX and leucovorin rescue versus those who received escalating doses of MTX and PEG asparaginase.

中文翻译：

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AALL0232协议中的神经认知功能

我想祝贺Hardy等¹在他们的报告中临床肿瘤学杂志分析患儿神经认知功能的危险高危急性淋巴细胞白血病（ALL）在AALL0213协议处理。该报告补充了Larsen等[ ^2]文章中提供的神经毒性数据，该数据仅讨论了癫痫发作和中风。Hardy等人的报告指出，增加亚叶酸（亚叶酸）的抢救减少了较低剂量甲氨蝶呤（MTX）后的毒性反应频率，以及MTX 33.6 gm / m ²后早期大剂量亚叶酸蛋白的毒性反应频率几乎没有引起急性或慢性神经毒性；然而，作者们并未对为何他们发现接受大剂量MTX和亚叶酸钙拯救的患者与接受递增剂量MTX和PEG天冬酰胺酶的患者在神经认知结果方面没有显着差异的原因没有提出任何解释。