Neuropsychological outcome in very young hematopoietic SCT recipients in relation to pretransplant conditioning

Abstract

Stem cell transplantation involves conditioning with TBI and/or intensive chemotherapy, which may cause longterm neuropsychological deficits, particularly in children treated at a very young age. The aim of this study was to investigate whether very young children who receive chemotherapy-based conditioning only (BUCY) may have a more favorable neuropsychological outcome than children conditioned with TBI-CY. Twenty-two children who underwent allogeneic SCT at 0.4-3.6 years of age were subject to an extensive neuropsychological assessment at an average of 6.5 years post-therapy. The test results of 10 children exposed to BU were compared to the results of 12 children who had received TBI. Ten of them had received single-dose TBI, whereas two had received fractionated TBI. The BU group performed at age level on verbal measures, but tended to score below age level in the executive and visuo-spatial domains (Po0.01). By comparison, children treated with TBI had more pervasive neuropsychological impairments, including motor deficits (Po0.01) and varying degrees of perceptual (Po0.05), executive and cognitive (Po0.05) problems. In conclusion, children transplanted at a very young age had a more favorable neuropsychological development if conditioned with BUCY than if conditioned with single-dose TBI-CY.

Adverse health events and late mortality after pediatric allogeneic hematopoietic SCT—two decades of longitudinal follow-up

“…A previous study showed less favorable neurocognitive outcomes after sTBI when compared with BU. 39 Although both centers had very similar follow-up routines and all the leukemia patients were treated according to the common Nordic leukemia treatment protocols, we cannot completely rule out some differences in the local follow-up routines or changes over time. Some data were harder to obtain.…”

Long-term cognitive outcome of childhood traumatic brain injury

“…Research involving subgroups of patients with a CTBI can be challenging, though. Since cohorts of clinical paediatric groups often are small and heterogeneous, the statistical analysis gets complicated (Smedler & Winiarski, 2008). Further division into subgroups based on different moderators diminishes the groups even more, further diminishing statistical power.…”

“…Seizures are commonly seen after repetitive concussions (Saunders et al, 2009). Neurotoxic agents can result in significant cognitive impairment, for example from cancer treatment to the central nervous system (Smedler & Winiarski, 2008;Butler & Copeland, 2002) and from chronic exposure to alcohol during gestation (Green et al, 2009). Further factors that have been highlighted as having an impact on brain integrity are pre-term birth.…”

Visual field results and optic disc morphology in patients treated with allogeneic stem-cell transplantation in childhood

“…This could be explained either by the circumstance that seven of the 11 patients with IOLs were found in the s-TBI group or by the fact that the TBI might have functionally impacted the brain and visual pathways (Hicks & D'Amato 1980;Locatelli et al 1993;Smedler & Winiarski 2008).…”

“…It is well known that TBI can damage the developing brain (Locatelli et al 1993;Smedler & Winiarski 2008) and also busulfan has been reported to be neurotoxic, causing Electroencephalogram (EEG) abnormalities (La Morgia et al 2004). Cyclosporine A can cause abnormalities revealed by magnetic resonance imaging (MRI) or computerized tomography (CT) (Bartynski et al 2004) and has also been associated with papilloedema (Avery et al 1991;Walter et al 2000) and cortical blindness (Taque et al 2004).…”