Sylvester Comprehensive Cancer Center

Daniel F. Armstrong, Ph.D.

Daniel F. Armstrong, Ph.D.

Professor of Pediatrics

Description of Research

Dr. Armstrong’s major interests in cancer research lie in the areas of neurocognitive late effects in children treated for brain tumors and acute lymphocytic leukemia (ALL), quality of life assessment in childhood cancer, interventions for cognitive late effects in childhood cancer survivors, and health behavior outcomes in long-term survivors of childhood cancer. Dr. Armstrong is the past chair of the Behavioral Sciences Committee of the Children’s Oncology Group, and is psychology study coordinator for ongoing COG studies of late neurocogntivie effects in children treated for medulloblastoma, ependymoma, ALL, and relapsed leukemia. and He was the Co-Principal Investigator of a Best Pharmaceuticals for Children Act supplemental grant to the NCI’s Children’s Oncology Group that has been investigating mechanisms (structure with diffusion tensor imaging, host polymorphisms, acute neurotoxic events) associated with neurocognitive outcomes in children treated for acute lymphoblastic leukemia. Dr. Armstrong’s clinical work involves neuropsychological evaluations and treatment recommendations for children treated for cancer. Dr. Armstrong’s team has completed a randomized, school-based clinical trial examining outcomes of different levels of intervention monitoring with children who have experienced neurocognitive cancer late effects. This project has resulted in the discovery of a possible link between leukemia treatment and later development of autism spectrum disorder symptoms. The next steps in this research program include (a) screening for autism spectrum disorder in a large sample of long-term survivors of acute lymphoblastic leukemia, with a subset being evaluated for possible cerebral folate deficiency and (b) implementation of a new randomized clinical trial comparing standard school intervention with enhanced school intervention that includes targeted assistive technology for children with neurocognitive late effects. The team is also preparing to examine very long-term (>25 years) neurocognitive follow-up of adults treated for childhood cancer.


  • Described a neurodevelopmental model for predicting late effects outcomes in children with cancer
  • Examining mechanisms associated with late neurocognitive effects of treatment with high dose methotrexate for acute lymphoblastic leukemia, including acute neurologic events, structural changes using diffusion tensor imaging, changes in the folate pathway, and contribution of genetic polymorphisms
  • Examining whether exposure to >2gms/m2 intravenous methotraxate during consolidation for acute lymphoblastic leukemia increases risk for later development of autism spectrum disorder symptoms
  • Examining the benefits of targeted use of assistive technology can improve neurocognitive and academic performance of longterm childhood cancer survivors.
  • Examining very long-term neurocognitive functioning of young adults (>35 years old) treated for acute lymphoblastic leukemia or CNS tumors as children.
  • Created agreements to establish a network of 11 pediatric cancer programs in Florida to conduct behavioral/late effects research on childhood cancer

Selected Cancer-Related Publications

  • Armstrong FD. Implications of 25-Year Follow-Up of White Matter Integrity and Neurocognitive Function of Childhood Leukemia Survivors: A Wake-Up Call. J Clin Oncol :,2013 Read more »
  • Ris MD, Walsh K, Wallace D, Armstrong FD, Holmes E, Gajjar A, Zhou T, Packer RJ. Intellectual and academic outcome following two chemotherapy regimens and radiotherapy for average-risk medulloblastoma: COG A9961. Pediatr Blood Cancer 60:1350-7,2013 Read more »
  • Armstrong FD. Proton-beam radiation therapy and health-related quality of life in children with CNS tumors. J Clin Oncol 30:2028-9,2012 Read more »
  • Jean-Pierre P, Winters PC, Ahles TA, Antoni M, Armstrong FD, Penedo F, Lipshultz SE, Miller TL, Fiscella K. Prevalence of self-reported memory problems in adult cancer survivors: a national cross-sectional study. J Oncol Pract 8:30-4,2012 Read more »
  • Vichinsky EP, Neumayr LD, Gold JI, Weiner MW, Rule RR, Truran D, Kasten J, Eggleston B, Kesler K, McMahon L, Orringer EP, Harrington T, Kalinyak K, De Castro LM, Kutlar A, Rutherford CJ, Johnson C, Bessman JD, Jordan LB, Armstrong FD. Neuropsychological dysfunction and neuroimaging abnormalities in neurologically intact adults with sickle cell anemia. JAMA 303:1823-31, 2010 Read more »
  • Steinberg MH, McCarthy WF, Castro O, Ballas SK, Armstrong FD, Smith W, Ataga K, Swerdlow P, Kutlar A, DeCastro L, Waclawiw MA. The risks and benefits of long-term use of hydroxyurea in sickle cell anemia: A 17.5 year follow-up. Am J Hematol 85:403-8, 2010 Read more »


Collaborating in the Multidisciplinary Research Program(s):

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