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A prospective study of cognitive functioning following low-dose cranial radiation for bone marrow transplantation
J H Kramer1, M R Crittenden, F E Halberg
1University of California, San Francisco Medical Center 94143.
Insights
Low-dose cranial irradiation in children undergoing bone marrow transplant showed no significant negative effects on psychological development one year post-treatment. Some individual cases experienced IQ declines, warranting cautious interpretation of long-term cognitive outcomes.
Area of Science:
- Pediatric Oncology
- Neuroscience
- Developmental Psychology
Background:
- Cranial irradiation is used in conditioning regimens for bone marrow transplantation.
- Potential neurocognitive and psychosocial effects in pediatric patients are a significant concern.
Purpose of the Study:
- To prospectively evaluate the impact of low-dose cranial irradiation on psychological development in children undergoing bone marrow transplantation.
- To assess intellectual and psychosocial functioning at one and three years post-transplant.
Main Methods:
- Prospective study comparing 15 irradiated children (350-1200 cGy) with 7 non-irradiated controls.
- Intellectual and psychosocial development measures administered pre-transplant and at one-year follow-up.
- A subset of children was followed for three years.
Main Results:
- No significant decrements in overall psychological functioning were observed at one-year follow-up.
- No significant differences in test scores relative to baseline were found in the three-year cohort.
- Individual case analysis revealed variability, with 7 children showing IQ decrements of 10+ points at one year.
Conclusions:
- Low-dose cranial irradiation (<1500 cGy) appears relatively well-tolerated regarding long-term cognitive and psychosocial development in children.
- Caution is advised due to observed individual variability and limited follow-up duration.
Abstract:
This study prospectively examined the effects of low doses of cranial irradiation on psychological development in children. The subjects were 22 children receiving bone marrow transplantation. Fifteen children receiving cranial doses ranging from 350 to 1200 cGy as part of their conditioning regimen were contrasted to seven children who were not irradiated. Measures of intellectual and psychosocial development were administered to all subjects prior to transplant and again at one-year posttransplant. There were no decrements in psychological functioning at the one-year follow-up, regardless of the dose of cranial radiation received or the age at which radiation was administered. In addition, there were no significant differences in test scores relative to baseline in a smaller cohort of children followed up for 3 years. Although no significant between-group findings were found, examination of individual cases revealed a high degree of variability, with decrements in IQ of 10 points or more found in 7 children at the one-year follow-up. Findings suggest that doses less than 1500 cGy may prove to be relatively well tolerated with respect to long-term cognitive and psychosocial development, even in young children, although caution is urged in light of the limited length of follow-up.