In Reply It is well recognized that long-term survivors of childhood acute lymphoblastic leukemia treated without cranial irradiation are still at increased risk for neurocognitive impairment and neuroimaging abnormalities. These outcomes have previously been associated with treatment with intrathecal chemotherapy and high-dose intravenous methotrexate.1,2 However, these treatments alone could not explain all the variance in neurocognitive outcomes, and other risk factors, such as genetic predispositions, infections, and stroke, have been identified.3 It is important to identify these multiple risk factors to develop interventions for each to improve outcomes. In our recently published study,4 we identified exposure to general anesthesia (ie, propofol, fluranes, cumulative duration of anesthesia) as another risk factor associated with neurocognitive impairment in long-term survivors of childhood acute lymphoblastic leukemia. This article has drawn much attention, including the 2 letters by Colquhoun and Mathis and Ishida and Kuratani.
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Krull KR, Pui C. Association of Anesthesia Care and Cognitive Outcomes in Survivors of Childhood Acute Lymphoblastic Leukemia—Reply. JAMA Oncol. Published online November 14, 2019. doi:https://doi.org/10.1001/jamaoncol.2019.4903
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