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Principal Investigator: Austin L Brown
Organization: BAYLOR COLLEGE OF MEDICINE
Fiscal Year: 2024
Award: $610,229
Funding agency: National Cancer Institute
PROJECT SUMMARY/ABSTRACT
Latino children experience increased incidence of acute lymphoblastic leukemia (ALL), as well as disparities
in treatment response, relapse, and survival. However, to date, there have been few studies evaluating the
impact of persistent neurocognitive symptoms on educational and economic outcomes in Latino survivors. What
has been demonstrated by our group and others is that disparities among Latino children with ALL are not fully
explained by non-genetic factors, such as differences in treatment adherence. In fact, biological factors
contribute to these outcomes: Native American genetic ancestry has been implicated in relapse among Latinos
with ALL and is related to neurotoxicity during treatment. Building from this work, we explore two unanswered
questions: 1) what is the burden of neurocognitive deficits among Latino children diagnosed with ALL relative to
non-Latino children, and 2) what is the relative contribution of clinical, socioeconomic, cultural, and biological
factors in explaining neurocognitive disparities among childhood ALL survivors. We will leverage our ongoing
Reducing Ethnic Disparities in Acute Leukemia (REDIAL) cohort to conduct deep neurocognitive phenotyping in
a subset of the population (N=400) diagnosed and treated for ALL – with a particular focus on Latinos, who make
up more than 50 percent of the ongoing cohort. We will model neurocognitive performance from diagnosis
through 7 years post-diagnosis by employing an accelerated longitudinal cohort design, which includes annual
assessments for: 1) newly diagnosed patients in the first years of the grant (Wave 1, n = 200); and 2) survivors
who are 3-7 years post diagnosis (Wave 2, n = 200). We also incorporate factors that have yet to be included in
models of neurocognitive outcomes among children diagnosed with ALL, such as measures of socioeconomic
status (SES), acculturation, English-language proficiency, and genetic ancestry. Our research aims are to: 1)
characterize the trajectory of neurocognitive performance in Latino children diagnosed with ALL; 2) examine the
impact of clinical, individual and neighborhood socioeconomic factors, and level of acculturation among Latinos;
and 3) assess the relative contribution of genetic ancestry to neurocognitive performance in children diagnosed
with ALL. Strengths of our approach include rigorous preliminary data, a recruitment infrastructure for enrolling
Latino patients diagnosed with ALL, existing data and samples collected as part of our ongoing REDIAL cohort,
an unparalleled research environment, and a geographical region that is ethnically and socioeconomically
diverse. This proposal has significant translational potential to improve the clinical management of
neurocognitive outcomes in this population, as it will identify children at risk for neurocognitive difficulties and in
greatest need of intervention, critical points in treatment/survivorship when intervention strategies may help to
mitigate disparities in neurocognitive outcomes, and targets for intervention.
Terms: <0-11 years old><21+ years old><Acceleration><Accounting><Acculturation><Acute Lymphoblastic Leukemia><Acute Lymphocytic Leukemia><Acute Lymphoid Leukemia><Acute leukemia><Address><Adult><Adult Human><After Care><After-Treatment><Aftercare><Attention><Biologic Factor><Biological><Biological Factors><Brain Vascular><Child><Child Youth><Childhood ALL><Childhood Acute Lymphoblastic Leukemia><Childhood Acute Lymphocytic Leukemia><Childhood Acute Lymphogenous Leukemia><Childhood Acute Lymphoid Leukemia><Childhood Cancers><Childhood Leukemia><Children (0-21)><Clinical><Clinical Management><Clinical Oncology><Cultural Assimilation><Data><Decrease disparity><Diagnosis><Disparities><Disparity><Doctor of Philosophy><Education><Educational aspects><Employment><English Language><Enrollment><Environment><Epidemiologist><Epidemiology><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Event><Foundations><Funding><General Population><General Public><Genetic><Geographic Area><Geographic Locations><Geographic Region><Geographical Location><Goals><Grant><IQ Deficit><Immediate Memory><Incidence><Individual><Infrastructure><Injury><Intervention><Intervention Strategies><Investigators><L1 Lymphocytic Leukemia><Latino><Latino Population><Latino group><Latino individual><Latino people><Latinos><Leukemia Acute Lymphoblastic Chemotherapy><Long-term cohort><Longitudinal cohort><Longterm cohort><Lower disparity><Lymphoblastic Leukemia, Acute, L1><Malignant Childhood Neoplasm><Malignant Childhood Tumor><Malignant Pediatric Neoplasm><Malignant Pediatric Tumor><Malignant childhood cancer><Measures><Modeling><Native American Ancestry><Native American genetic ancestry><Neighborhoods><Neurocognitive><Neurocognitive Deficit><Neuropsychologies><Neuropsychology><Newly Diagnosed><Outcome><Participant><Patients><Pediatric ALL><Pediatric Acute Lymphoblastic Leukemia><Pediatric Acute Lymphocytic Leukemia><Pediatric Acute Lymphogenous Leukemia><Pediatric Acute Lymphoid Leukemia><Pediatric Leukemia><Performance><Ph.D.><PhD><Phenotype><Population><Precursor Cell Lymphoblastic Leukemia><Precursor Lymphoblastic Leukemia><Principal Investigator><QOL><Quality of life><Relapse><Research><Research Personnel><Research Resources><Researchers><Resources><Risk><Risk Factors><Sampling><Seizures><Short-Term Memory><Shortterm Memory><Socio-economic status><Socioeconomic Factors><Socioeconomic Status><Survivors><Symptoms><Time><Treatment-related toxicity><Work><Youth><Youth 10-21><acute lymphatic leukemia><acute lymphoblastic leukemia Chemotherapy><acute lymphogenous leukemia><acute lymphomatic leukemia><adulthood><bilingual><bilingualism><biologic><cancer in a child><cancer in children><cerebral vascular><cerebro-vascular><cerebrovascular><child with cancer><childhood malignancy><children with leukemia><cohort><compare treatment><design><designing><disparities in treatment><disparity in ethnic><disparity in health><disparity reduction><economic outcome><enroll><epidemiologic><epidemiological><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnic subgroup><ethnicity disparity><ethnicity group><executive control><executive function><experience><geographic site><health disparity><improved><improved outcome><inattention><inattentiveness><inequality in treatment><infant ALL><injuries><intelligence quotient deficit><interventional strategy><kids><leukemia in children><mitigate disparity><multi-ethnic><multidisciplinary><multiethnic><neurocognitive decline><neurocognitive impairment><neuron toxicity><neuronal toxicity><neuropsychologic><neurotoxic><neurotoxicity><non-genetic><nongenetic><novel><patient population><pediatric cancer><pediatric malignancy><post treatment><processing speed><protective factors><recruit><reduce disparity><reduction in disparity><response><response to therapy><response to treatment><social health determinants><socio-economic><socio-economic factors><socio-economic position><socio-economically><socioeconomic position><socioeconomically><socioeconomics><survivorship><therapeutic response><therapeutic toxicity><therapy associated toxicity><therapy related toxicity><therapy response><therapy toxicity><translational opportunities><translational potential><treatment adherence><treatment comparison><treatment compliance><treatment disparity><treatment inequality><treatment inequity><treatment response><treatment responsiveness><treatment toxicity><treatment-associated toxicity><white matter injury><working memory><youngster>