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Impact of Propofol Exposure on Neurocognitive Outcomes in Children With High-Risk B ALL: A Children's Oncology Group

Sarah Alexander1, John A Kairalla2, Sumit Gupta1

  • 1Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|April 11, 2024
PubMed

Insights

Children with acute lymphoblastic leukemia (ALL) exposed to propofol anesthesia showed impaired reaction time and processing speed. Reducing propofol use may mitigate these long-term neurocognitive risks in pediatric cancer patients.

Area of Science:

  • Pediatric Oncology
  • Neuroscience
  • Anesthesiology

Background:

  • Children with acute lymphoblastic leukemia (ALL) often experience long-term neurocognitive impairments.
  • Treatment and demographic factors are known risks, with anesthesia exposure being a potential additional factor.
  • This study investigated the link between cumulative anesthesia exposure and neurocognitive outcomes in pediatric ALL patients.

Purpose of the Study:

  • To evaluate the impact of cumulative anesthesia exposure on neurocognitive outcomes in children treated for ALL.
  • To identify specific anesthetic agents associated with neurocognitive deficits.
  • To inform strategies for mitigating treatment-related neurotoxicity.

Main Methods:

  • A multicenter cohort of children (ages 6-12) with high-risk B-cell ALL (B-ALL) from the AALL1131 trial were assessed.
  • Prospective neurocognitive function tests were administered during and one year after therapy.
  • Multivariable regression analyzed associations between cumulative anesthetic exposure (especially propofol) and reaction time/processing speed, adjusting for covariates.

Main Results:

  • 144 children underwent a median of 27 anesthetic episodes, with nearly all exposed to propofol.
  • One year post-therapy, a significant proportion of children exhibited neurocognitive impairment compared to normative data.
  • Cumulative propofol exposure was independently associated with a decrease in reaction time/processing speed (0.05 Z-score per 10 mg/kg, P=.03).

Conclusions:

  • Cumulative propofol exposure is an independent risk factor for impaired reaction time and processing speed in children with B-ALL.
  • Anesthesia exposure represents a modifiable risk factor for neurocognitive deficits.
  • Minimizing propofol use in pediatric ALL treatment should be considered to improve long-term outcomes.
Abstract

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