An Integrative Approach to Evaluate Neurocognitive Disparities in Latinos Undergoing Treatment for Childhood Leukemia.

评估接受儿童白血病治疗的拉丁裔神经认知差异的综合方法。

• 批准号: 10459987
• 负责人: Philip Lupo
• 金额: $ 61.9万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10459987
• 关键词: Accounting; Acculturation; Acute Lymphocytic Leukemia; Acute leukemia; Address; Adult; Aftercare; Attention; Biological; Biological Factors; Child; Childhood Acute Lymphocytic Leukemia; Childhood Cancer Treatment; Childhood Leukemia; Clinical; Clinical Management; Clinical Oncology; Data; Diagnosis; Doctor of Philosophy; English Language; Enrollment; Environment; Epidemiologist; Epidemiology; Ethnic Origin; Ethnic group; Event; Foundations; Funding; General Population; Genetic; Geographic Locations; Goals; Grant; Incidence; Individual; Infrastructure; Injury; Intervention; Latino; Latino Population; Leukemia Acute Lymphoblastic Chemotherapy; Longitudinal cohort; Measures; Modeling; Native American Ancestry; Neighborhoods; Neurocognitive; Neurocognitive Deficit; Neuropsychology; Newly Diagnosed; Outcome; Participant; Patients; Performance; Phenotype; Population; Principal Investigator; Quality of life; Relapse; Research; Research Personnel; Resources; Risk; Risk Factors; Sampling; Seizures; Short-Term Memory; Socioeconomic Factors; Socioeconomic Status; Survivors; Symptoms; Time; Treatment-related toxicity; Work; Youth; base; bilingualism; cerebrovascular; cohort; design; economic outcome; ethnic disparity; executive function; experience; health disparity; improved; improved outcome; inattention; multi-ethnic; multidisciplinary; neurotoxic; neurotoxicity; non-genetic; novel; patient population; processing speed; protective factors; recruit; response; social health determinants; socioeconomics; survivorship; translational potential; treatment adherence; treatment comparison; treatment disparity; treatment response; white matter injury

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.

项目摘要/摘要 拉丁裔儿童经历急性淋巴细胞白血病的发生率增加（所有）以及差异 在治疗反应，中继和生存中。但是，迄今为止，很少有研究评估 持续的神经认知症状对拉丁裔幸存者教育和经济成果的影响。什么 我们的小组和其他人都证明了拉丁裔儿童的分布 用非遗传因素解释，例如治疗依从性的差异。实际上，生物学因素 为这些结果做出贡献：美国原住民的遗传血统在拉丁美洲人的退休中隐含 与所有人有关，与治疗过程中的神经毒性有关。通过这项工作建立，我们探索了两个未解决的问题 问题：1）在被诊断出患有所有相对于的拉丁裔儿童中神经认知防御的燃烧是什么 非拉丁裔儿童和2）临床，社会经济，文化和生物学的相对贡献是什么 解释儿童期所有生存的神经认知分布的因素。我们将利用我们正在进行的 降低急性白血病（REDIAIL）队列中的种族差异，以进行深度神经认知表型 诊断和治疗的一部分人口（n = 400），特别关注拉丁裔，他们 超过50％的正在进行的队列。我们将对诊断的神经认知性能进行建模 诊断后7年，采用加速的纵向队列设计，其中包括年度 评估：1）在赠款的头几年中，新诊断的患者（第1波，n = 200）； 2）生存 诊断后3 - 7年（第2浪，n = 200）。我们还结合了尚未包含的因素 被诊断出患有所有人的儿童的神经认知结果模型，例如社会经济的度量 地位（SES），适应，英语水平和遗传血统。我们的研究目的是：1） 表征被诊断为所有人的拉丁裔儿童的神经认知表现的轨迹； 2）检查 临床，个人和社区社会经济因素以及拉丁美洲裔培养水平的影响； 3）评估遗传血统对被诊断儿童神经认知表现的相对贡献 所有人。我们方法的优势包括严格的初步数据，招聘基础设施 拉丁裔患者被诊断为所有人，现有数据和样本，作为我们正在进行的重复队列的一部分， 无与伦比的研究环境，以及一个种族和社会经济的地理区域 潜水员。该建议具有改善的临床管理的巨大转化潜力 该人群中的神经认知结果，因为它将确定有神经认知困难的风险的儿童 最需要干预，干预策略可能有助于治疗/生存的关键点 减轻神经认知结果中的分布，以及干预的靶标。