Organ preservation.

This time we mean preserving our favorite organ: the brain. Brain radiation in children has a bad rap, so most trials over the past several decades have focused on de-escalating or replacing radiation with more chemo. Sadly, eliminating radiation from recent protocols for acute lymphoblastic leukemia (ALL) hasn’t eliminated longterm cognitive detriments. Researchers from St. Jude are now focusing on the neurotoxicity they’re seeing with chemo alone. Their novel study reports the discovery of cerebrospinal fluid (CSF) biomarkers as predictors of acute and(!) long term neurotoxicity with chemo-only protocols for pediatric ALL. Remarkably, specific markers of glial and neuronal injury--as measured at 5 time points during chemo--were significantly associated with a host of poorer cognitive outcomes 5 or more years later. TBL: The door has been cracked to biology-based, neurotoxicity-risk adaptive pediatric protocols. | Cheung, JAMA Oncol 2018