Faculty Showcase Chemotherapy-Induced Central Nervous System Injury in Children with Leukemia	Dr. Ki Moore, RN, DNS, FAAN
Ki Moore, RN, DNS, FAAN Professor and Director Nursing Practice Division kmoore@nursing.arizona.edu

	One aim of our research is to investigate the effects of CNS treatment on cognitive and behavioral outcomes among children with acute lymphoblastic leukemia. A second aim is to investigate mechanisms of treatment-related CNS injury. The long-term goal is to improve cognitive and academic outcomes among children with acute lymphoblastic leukemia. Our research focuses on how methotrexate damages non-malignant cells in the central nervous system and how such damage results in cognitive and academic problems. We are also developing and testing interventions to improve cognitive and academic outcomes.  We conduct clinical studies with children with leukemia and cell culture studies focused on mechanisms of cellular injury.
	Our research involves clinical and laboratory studies designed to increase understanding about the mechanisms of chemotherapy-induced injury to the central nervous system in children with acute lymphoblastic leukemia. These studies involve cell culture studies and cerebral spinal fluid analysis of biological markers of cell injury. We are also conducting a randomized trial of a Math Intervention designed to prevent declines in math abilities and to improve math abilities in children with documented deficits in this area of academic abilities.
	Acute lymphoblastic leukemia (ALL) is the most common cancer among children and adolescents less than 15 years of age in the United States.  Because of dramatic advances in ALL treatment, five-year disease-free survival approaches 85%.  The central nervous system (CNS) is a sanctuary site for leukemia cells, therefore, CNS treatment is essential for maintaining disease remission. Almost all CNS treatment regimens use intrathecal methotrexate alone, or in combination with intermediate- or high-dose systemic methotrexate, administered at specific intervals throughout ALL treatment. Unfortunately CNS treatment with methotrexate is also associated with cognitive and academic problems that progress over time and are associated with behavioral adjustment problems such as depression and withdrawal. Our current project is testing the efficacy of a Math Intervention. Findings demonstrate that the intervention prevens declines in math abilities.  The goal of future studies is to design and test alternative methods of intervention delivery. A second goal is to investigate oxidative damage as a mechanism of CNS injury that may contribute to cognitive and academic problems among children with leukemia. contact kmoore@nursing.arizona.edu