Alterations in Memory and Impact on Academic Outcomes in Children Following Allogeneic Hematopoietic Cell
R Lajiness-O'Neill1, F Hoodin2, R Kentor3
1Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA rlajines@emich.edu.
Insights
Allogeneic hematopoietic cell transplantation (HCT) for pediatric leukemia has high rates of chronic conditions. Neurocognitive deficits in processing speed and memory significantly impact academic outcomes in survivors.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Hematology
Background:
- Allogeneic hematopoietic cell transplantation (HCT) offers a cure for pediatric leukemia but is associated with high rates of chronic medical conditions (79%).
- Cognitive late effects of HCT are not well understood, with limited research focusing on intelligence and yielding equivocal results regarding neurotoxicity.
- Existing studies have not comprehensively evaluated neuropsychological predictors of academic performance in pediatric HCT survivors.
Purpose of the Study:
- To investigate neuropsychological predictors of academic outcomes in children treated with allogeneic HCT for leukemia.
- To characterize cognitive late effects, specifically focusing on attention, memory, and processing speed.
- To identify medical factors associated with cognitive outcomes and academic performance.
Main Methods:
- Archival study of 30 pediatric leukemia survivors who underwent allogeneic HCT (mean transplant age = 6 years).
- Neuropsychological assessments were administered to evaluate intellectual abilities, academic skills, attention, memory, and processing speed.
- Medical history, including acute graft-versus-host disease (GVHD) and steroid treatment, was analyzed for correlation with cognitive and academic outcomes.
Main Results:
- While mean intellectual and academic abilities were average, significant variability was observed, with approximately 25% of participants exhibiting borderline or lower performance in attention and memory.
- Paradoxically, more severe acute graft-versus-host disease (GVHD) and steroid treatment were associated with better memory function.
- Processing speed and memory significantly predicted academic outcomes, accounting for 69% of variance in mathematics and 61% in reading.
Conclusions:
- Allogeneic HCT for pediatric leukemia survivors is associated with neurocognitive vulnerabilities, particularly in processing speed and memory.
- These specific cognitive deficits are significant predictors of subsequent academic difficulties in mathematics and reading.
- Further research and targeted interventions are needed to address these late cognitive effects and improve academic success in HCT survivors.
Abstract:
The prevalence of late effects following allogeneic hematopoietic cell transplantation (HCT), a curative treatment for pediatric leukemia, is high: 79% of HCT recipients experience chronic medical conditions. The few extant studies of cognitive late effects have focused on intelligence and are equivocal about HCT neurotoxicity. In an archival study of 30 children (mean transplant age = 6 years), we characterize neuropsychological predictors of academic outcomes. Mean intellectual and academic abilities were average, but evidenced extreme variability, particularly on measures of attention and memory: ∼25% of the sample exhibited borderline performance or lower. Medical predictors of outcome revealed paradoxically better memory associated with more severe acute graft-versus-host disease (GVHD) and associated with steroid treatment. Processing speed and memory accounted for 69% and 61% of variance in mathematics and reading outcomes, respectively. Thus, our findings revealed neurocognitive areas of vulnerability in processing speed and memory following HCT that contribute to subsequent academic difficulties.
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