Symptoms, Physical Activity, and Biomarkers in Children at the End of Leukemia Maintenance Therapy

Mary C. Hooke, Derek L. Salisbury, Michelle A. Mathiason, Alicia S. Kunin-Batson, Audrey Blommer, Jessica Hutter, Pauline Mitby, Ida Moore, Susan Whitman, Olga Taylor, Michael E. Scheurer, Marilyn J. Hockenberry

Research output: Contribution to journalArticlepeer-review


Background: Symptoms in children with acute lymphocytic leukemia (ALL) change over the trajectory of treatment but little is known about their symptoms as treatment ends. Physical activity may help decrease symptom distress and is vital for ongoing development. The role of biomarkers in symptom science is emerging. The purpose of the study was to explore relationships between self-report of symptoms and physical activity, actigraphy measures, and cerebrospinal fluid (CSF) biomarkers. Methods: Participants were children who were ages 3 to 18 years at the time of ALL diagnosis and were now in the last 12-week cycle of ALL maintenance. Self-reports of fatigue, sleep disturbance, depressive symptoms, and physical activity were completed by participants and parents of younger children. Participants wore a wrist actigraph continuously for the 7 days before other measurements. F2-isoprostanes and interleukin-8 were evaluated in CSF samples. Results: Among the 15 participants, self-report of symptoms and physical activity indicated levels similar to healthy peers. F2-isoprostane had a strong positive correlation with fatigue levels and with depressive symptoms. Fatigue, sleep disturbance, and depressive symptoms positively correlated with each other. Actigraph measures showed children met the CDC guidelines for 60 min of daily moderate to vigorous activity; sleep time was slightly less than healthy norms. Discussion: During maintenance therapy, most children return to healthy norms in symptom burden and physical activity. F2-isoprostane in the CSF is a biomarker for fatigue and depressive symptoms. Children who had persistent symptoms experienced them as a cluster, which confirms previous symptom cluster research.

Original languageEnglish (US)
Pages (from-to)386-399
Number of pages14
JournalJournal of Pediatric Hematology/Oncology Nursing
Issue number6
StatePublished - Nov 1 2023

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Arthur Olofson Medical Research Fund at the University of Minnesota Foundation and National Institutes of Health (grant number R01CA1693398).

Publisher Copyright:
© 2023 by Association of Pediatric Hematology/Oncology Nurses.


  • biomarkers
  • depressive symptoms
  • fatigue
  • leukemia
  • physical activity
  • sleep disturbance

PubMed: MeSH publication types

  • Journal Article


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