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.

中文翻译：

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白血病患儿氧化应激、症状群和认知功能生物标志物的纵向平行过程分析

背景：在急性淋巴细胞白血病 (ALL) 的治疗过程中，儿童将疲劳、睡眠障碍、疼痛、恶心和抑郁等症状作为一组症状并存。以中枢神经系统为导向的 ALL 疗法也使儿童面临认知障碍的风险。癌症疗法会导致氧化应激增加，这可能会导致治疗相关症状。本研究检查了脑脊液氧化应激生物标志物、儿童癌症症状群 – 白血病 (CCSC-L) 和认知能力之间的纵向关系，在 ALL 治疗的第一年。方法：在腰椎穿刺治疗期间收集的脑脊液中测量氧化应激的谷胱甘肽 (GSH) 生物标志物。GSH 生物标志物、症状、在白血病治疗第一年的四个时间点评估了 132 名 3 至 18 岁儿童的认知功能和认知功能。7 岁及以上的参与者完成了自我报告措施，父母为年幼的孩子报告。所有参与者的认知功能测量均由父母完成。纵向平行过程模型用于探索初始测量和随后四个时间点 GSH 生物标志物的变化对 CCSC-L 和认知的影响。结果：GSH 生物标志物在四个时间点增加，表明氧化应激降低。当初始测量时 GSH 生物标志物较高（氧化应激较少）时，CCSC-L 的严重程度较低，认知更好，并且在四次测量中认知得到改善。