This randomized controlled clinical trial evaluates neurocognitive, biopsychological, and brain connectome outcomes in children and adolescents with acute lymphoblastic leukemia who have previously received Chimeric Antigen Receptor T-cell therapy (CAR T-cell therapy), chemotherapy, and/or hematopoietic stem cell transplantation (HSCT).
Participants will receive a multimodal, telematic psychological intervention combining digital cognitive training and an adapted mindfulness-based emotional regulation program. Outcomes will be compared with a waitlist control group and intervention sequences will be counterbalanced: (1) cognitive training followed by mindfulness; and (2) mindfulness followed by cognitive training.
Neurocognitive performance, emotional-behavioral functioning, executive functioning and EEG-based functional connectivity will be assessed at baseline, post-intervention and at 6 months follow-up.
Diagnosis of acute B-cell lymphoblastic leukemia.
Previous treatment with CAR-T therapy, chemotherapy, and/or hematopoietic stem cell transplantation.
Age between 8 and 18 years.
Native Spanish speaker or high proficiency in Spanish sufficient to understand study procedures and complete assessment instruments.
Diagnosis of intellectual disability, autism spectrum disorder, or acquired brain injury.
Presence of uncontrolled or unstable medical or psychiatric conditions unrelated to leukemia.
Crossover
Digital cognitive training
BehavioralAdaptive exercises targeting attention, processing speed, memory and executive functions. Twelve-week intervention via Sincrolab online platform (4 practices per week, 15 minutes each), with a weekly online group session to encourage adherence.
Online Mindfulness-Based Intervention
BehavioralAdapted Mindfulness-Based Stress Reduction (MBSR) program for children and adolescents. Twelve weekly online group sessions with guided home practice (4 practices, 15 minutes each) using audio materials.
Symbol Digit Modalities Test (SDMT).
It assesses processing speed based on the total number of items completed in 90 seconds. Scores range from 0 to a maximum determined by the speed of task completion. Higher scores indicate better processing speed. The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
Continuous Performance Test, third edition (CPT-3)
It assesses sustained visual attention, impulsivity, and vigilance through continuous performance tasks that require responses to target stimuli and inhibition of non-target stimuli. Outcome measures include omission errors, commission errors, reaction time, and variability, which are expressed as standardized T-scores. Higher T-scores indicate poorer performance. The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
Clinical Assessment of Memory (ECM)
It assesses working memory and immediate memory in auditory-verbal and visuospatial modalities. Scores are expressed as standardized scores based on Spanish norms. Higher scores indicate better memory performance. The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
Verbal Fluency Test (VFT)
Assesses linguistic and executive functions, including phonological and semantic fluency. The score is the total number of correct words generated in 60 seconds. Higher scores indicate better performance. The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
Behavior Rating Inventory of Executive Function, second edition (BRIEF-2)
63-item questionnaire that assesses the patient's executive functions (completed by parents). Higher scores in each domain indicate a worse outcome. Spanish norms in T scores (mean = 50; standard deviation = 10). The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
Behavior Assessment System for Children, third edition (BASC-3)
It measures patients' emotional and behavioral problems, both in the version completed by the patient's legal guardians and in the self-assessment carried out by the patient themselves. It is a report of 139 items, scored on a 4-point Likert frequency scale. High scores indicate problematic levels of functioning. Scores are reported as T-scores (mean = 50; standard deviation = 10). The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
Brief Pain Inventory (BPI)
This 10-question questionnaire includes questions (from 0 to 10, referring to the last 7 days) covering two dimensions: pain intensity (the most intense and mildest pain of the week, average pain, and current pain) and pain interference (in general activity, mood, walking, school, sleep, and enjoyment of life). Higher scores on a Likert scale of 0 to 10 indicate more pain. The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
Adolescent Insomnia Questionnaire (AIQ)
This is a 13-item questionnaire, the original version of which is in English. In this study, the questionnaire will be adapted and validated in Spanish. Higher scores on a Likert scale of 0 to 4 indicate greater insomnia. The scores will be converted to z-scores (mean = 0; standard deviation = 1) to equate and compare the values of instruments with different units of measurement.
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Hospital Universitario La Paz
Lead sponsor
Instituto de Investigación Hospital Universitario La Paz
Collaborator
