HJAR Jan/Feb 2026

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2026 39 Lauren Appell, MD Pediatric Oncologist/Hematologist Arkansas Children’s previous research, this project, funded by a $2.5 millionMethod to Extend Research in Time (MERIT) award grant with five years of support and the opportunity for a two-year extension, advances the field by identify- ing some of the earliest brain and cognitive changes that occur during or shortly after treatment. Empowering Survivors Through Physical Activity The second project, funded as a K12 In- stitutional Career Development Program, is the “Strength and Outpatient Exercise Regi- men in Children withAcute Lymphoblastic Leukemia/Lymphoma (STRONGERALL).”It focuses on metabolic syndromes and car- diometabolic disease, including high blood pressure, high blood sugar, and unhealthy cholesterol levels, impacted by some cancer treatments. The late (those starting after treatment) and long-term (those starting during treat- ment and continuing after treatment ends) side effects of cancer therapies can affect all organs and systems. Survivors of cancer can experience bowel or bladder problems, mental health issues or skeletal issues. Che- motherapy, radiation, and surgery can lead to hormonal imbalances and organ dam- age, increasing the risk of cardiovascular disease and diabetes. These effects can be unintentionally compounded through life- style choices that sometimes develop out of not having enough time or energy to be more physically active when treatments are time-consuming and taxing. The STRONGERALLproject measures the impact of increasing physical exercise dur- ing treatments, with the intent of improving the quality of life for survivors. It will also add to the body of knowledge regarding the capabilities of patients undergoing treat- ment. It should be noted that there are no consensus guidelines for what is safe or do- able for physical activity for children who are actively receiving chemo for ALL. This interventional study involves mon- itoring participants, ages 11 to 21, during 30-minute workouts three times a week for a year. Physical trainers monitor par- ticipants virtually via provided home exer- cise equipment or in person at theArkansas Children’s Nutrition Center in Little Rock. Early feasibility results —measured by re- cruitment, adherence, and patient feedback on applicability — are encouraging. Patients often say they feel helpless and powerless when they get a diagnosis of ALL, but proj- ect participants have commented that par- ticipating in this project empowers them to take charge of their health; it gives them hope of getting healthier while undergoing treatment. Together, these projects are uncovering critical insights into brain development and physical health in children with ALL. By identifying neurocognitive changes early in treatment and testing structured exercise programs during therapy, researchers are working to reduce the long-term effects of pediatric leukemia and its treatments. The findings of these and other innovative stud- ies in this space are shaping a more com- prehensive approach to care — one that looks beyond survival to overall well-being throughout survivorship. n Ellen van der Plas, PhD, is a researcher at Arkansas Children’s Research Institute and associate professor of pediatric hematology/oncology at the University of Arkansas for Medical Sciences. LaurenAppell,MD, is a pediatric oncologist/hematol- ogist atArkansas Children’s and assistant professor in the department of pediatrics at UAMS. The project has three specific aims: • Identifying changes in discrete compo- nents of executive function in pediatric leukemia patients and healthy peers; • Identifying differences in neurodevel- opmental changes between leukemia patients and healthy peers; and • Examining neurochemical markers of brain injury in cerebrospinal fluid sam- ples in leukemia patients and evaluat- ing their relationship with neurodevel- opmental outcomes. To achieve these goals, children with and without leukemia, ages 3 to 10, are assessed three times over the course of a year. During each visit, they complete puzzles and games that measure thinking and planning skills and undergo a non-sedated MRI scan. The MRI uses specialized techniques to capture different aspects of the brain, including its structure, connections, activity, and chemi- cal makeup. Analysis of leftover cerebrospi- nal fluid provides data about protein mark- ers of brain injury. Initial results of the project suggest some mental functions — such as remembering visual and spatial information, thinking flex- ibly, and controlling impulses — are weaker in children with leukemia compared with their healthy peers. Additionally, the brain’s white matter, particularly in the frontal lobes, shows reduced integrity in leukemia pa- tients compared to their peers, and early signs of an “energy crisis”are apparent, with certain brain chemicals elevated while oth- ers are reduced. Previous research shows that leukemia survivors, even decades after treatment, of- ten exhibit changes in brain structure, par- ticularly in white matter, and experience cognitive difficulties that can affect school and work performance. Building on that