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Cognitive and adaptive behavior 1 and 3 years following bone marrow transplantation
J H Kramer1, M R Crittenden, K DeSantes
1University of California, San Francisco Medical Center 94143, USA.
Insights
Children undergoing bone marrow transplant (BMT) experience declines in intellectual and adaptive functioning one year post-procedure. These neurocognitive effects, including IQ and adaptive behavior, remained stable at the three-year follow-up.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Child Development
Background:
- Bone marrow transplant (BMT) treatments, including chemotherapy and total body irradiation, pose risks for long-term neurocognitive deficits in children.
- Assessing intellectual and adaptive functioning is crucial for understanding the late effects of BMT in pediatric populations.
Purpose of the Study:
- To prospectively and longitudinally evaluate the intellectual and adaptive functioning of children undergoing bone marrow transplant.
- To identify potential factors influencing neurodevelopmental outcomes after BMT.
Main Methods:
- Sixty-seven children were assessed at baseline before BMT and at 1-year follow-up using IQ and Vineland Adaptive Behavior Scales.
- A subset of 26 children received a 3-year follow-up evaluation.
- Repeated-measures ANOVA and multivariate analyses were used to analyze changes in functioning and influencing factors.
Main Results:
- A significant decline in IQ was observed between baseline and the 1-year follow-up post-BMT.
- Adaptive behavior scores also significantly decreased by the 1-year follow-up.
- No further significant changes in IQ or adaptive behavior were noted between the 1-year and 3-year follow-up evaluations.
- No specific independent variables, such as diagnosis or radiation dose, predicted these outcomes.
Conclusions:
- Children undergoing BMT experience significant neurocognitive and adaptive functioning declines within the first year after treatment.
- These deficits appear to stabilize by the 1-year mark, with no further deterioration observed up to 3 years post-transplant.
- Further research is needed to explore underlying mechanisms and potential interventions for these late effects.
Abstract:
Children receiving a bone marrow transplant (BMT) are at risk for neuropsychological late effects because of potentially neurotoxic chemotherapy and total body irradiation. The goal of this study was to prospectively and longitudinally assess the intellectual and adaptive functioning of children receiving a BMT. This study examined 67 children whose development was evaluated at baseline prior to BMT and at 1 year follow-up. Mean age at BMT was 45 months. Repeated-measures ANOVA indicated a significant decline in IQ between baseline and the 1 year follow-up evaluation. Multivariate and exploratory univariate analyses examined the potential influence of diagnosis, treatment regimen, cranial radiation dose, age at time of transplant, and sex of child but none of these independent variables predicted outcome. Twenty-six children (mean age at BMT of 28.4 months) were also given developmental evaluations 3 years post-BMT. Although IQ at the 1 year follow-up was significantly lower than baseline, no further changes were evident at the 3 year follow-up evaluation. Scores on the Vineland Adaptive Behavior Scales also dropped significantly between baseline and the 1 year follow-up, but did not change between the 1 year and 3 year evaluations.