Postacute Neurocognitive Sequelae Following Pediatric Chemotherapy: A Retrospective Study From the Montefiore Survivorship Clinic (2000-2024)

PURPOSE: Standard neurocognitive and imaging assessments in research settings may not fully capture the real-world symptom burden experienced by pediatric hematologic cancer survivors. We conducted a retrospective analysis using electronic medical record data to evaluate cognitive and imaging findings as well as comorbidities in this patient population. MATERIALS AND METHODS: We retrospectively reviewed data from 314 pediatric blood cancer survivors (diagnosed at age ≤21) followed at the Montefiore Survivorship Clinic between 2000 and 2024. Neurocognitive assessments, neuroimaging, and treatment exposures were extracted. The chi-square test was used for group comparison of categorical variables, and the independent t-test was used for group comparison of continuous variables. The risk of developing a neurocognitive complaint was assessed using a multivariable Cox-proportional hazards model. RESULTS: < .005) were independently associated with increased risk of neurocognitive complaints. Neurocognitive testing revealed deficits across multiple domains, with most pronounced impairments in full-scale intelligence quotient (mean percentile: 27%) and verbal comprehension (mean percentile: 31%). Consistent neuroimaging abnormalities, including white matter changes and T2 hyperintensities, were observed in 25% of symptomatic patients, although most had unremarkable findings, suggesting underlying microstructural or functional disruptions undetected by standard imaging. CONCLUSION: Chemotherapy-related neurocognitive dysfunction affects nearly one in five pediatric hematologic cancer survivors, with younger age at diagnosis and methotrexate exposure as major risk factors.