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.