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Total body irradiation: a neuropsychological risk factor in pediatric bone marrow transplant recipients
A C Smedler1, C Nilsson, P Bolme
1Department of Psychology, Stockholm University, Sweden.
Insights
Pediatric bone marrow transplantation (BMT), especially with total body irradiation (TBI), may cause long-term neurodevelopmental issues in children. Early BMT (ages 3-11) was linked to deficits in motor speed, problem-solving, and verbal reasoning.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Hematology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for leukemia and severe aplastic anemia (SAA).
- Conditioning regimens often include cyclophosphamide and total body irradiation (TBI), raising concerns about potential long-term neuropsychological effects in pediatric patients.
Purpose of the Study:
- To longitudinally assess the neuropsychological outcomes in children undergoing BMT.
- To investigate potential deficits related to age at treatment and the use of TBI.
Main Methods:
- A longitudinal study involving 30 pediatric BMT recipients (leukemia or SAA) and their sibling donors.
- Neuropsychological examinations were conducted in 1986, 1988, and a third follow-up in 1990-91.
- Patients were grouped by age at BMT: 3-11 years (n=15) and 12-17 years (n=11).
Main Results:
- No neuropsychological deficits were observed in the older patient group (12-17 years) or in non-irradiated SAA patients.
- Children treated with BMT including TBI at ages 3-11 showed reduced performance in perceptual and fine-motor speed compared to donors in the first follow-up.
- This younger group also exhibited deficits in non-verbal problem-solving (second follow-up) and a decline in verbal reasoning (third follow-up, 5.5-10 years post-treatment).
Conclusions:
- BMT, particularly when including TBI in younger children (3-11 years), is associated with persistent neuropsychological impairments.
- These deficits manifest as difficulties in motor speed, problem-solving, and verbal reasoning over time.
- Close monitoring for developmental difficulties is recommended for pediatric BMT survivors, especially those who received TBI.
Abstract:
Bone marrow transplantation (BMT) involves conditioning with cyclophosphamide and, for leukemic patients, total body irradiation (TBI). Based on the concern that this may lead to later neuropsychologic impairment in children, a longitudinal study was conducted. Thirty pediatric bone marrow transplant recipients, treated for leukemia or severe aplastic anemia (SAA), and their sibling donors, were given a neuropsychological examination in 1986 and 1988. A third follow-up study of patients treated before 12 years of age was undertaken in 1990-91. We present longitudinal data on patients treated with BMT when 3-11 (n = 15) and 12-17 (n = 11) years old. No neuropsychological deficits were found in the older group, or among non-irradiated SAA patients. In the first follow-up, children treated with BMT, including TBI at 3-11 years of age, performed less well than donors on tasks involving perceptual and fine-motor speed. In the second follow-up, this group of patients also demonstrated a slight deficit in non-verbal problem solving. An additional relative decline in verbal reasoning was noted in the third follow-up, 5.5-10 years after treatment. Alertness to signs of developmental difficulties in children treated with BMT, including TBI, is recommended.