Total body irradiation: a neuropsychological risk factor in pediatric bone marrow transplant recipients

Summary:A total of 52 children, age 9 or over and at least 3 years (median ¼ 8) beyond SCT for leukaemia (n ¼ 32) or nonmalignant diseases, participated in a single-centre study of health and quality of life (QoL). QoL and self-esteem were assessed with SCHQ-CF87, a generic multidimensional self-report instrument, and with 'I think I am'. As a group, the children had good QoL, but were below norm in the bodily pain (Po0.05), general health and self-esteem dimensions (Po0.01). Lansky or Karnofsky function levels were at a median of 90. Sense of coherence (SOC-13) was normal and correlated with SCHQ-CF87. Most children were subjectively and objectively in good health according to a self-assessment symptom inventory or by a medical record-based scoring of late effects, although pain was commonly reported. A total of 25% of the patients were rated as having moderate to severe late effects, without considering cataracts or infertility. Neither age at SCT, gender, malignant vs nonmalignant disease, nor stature influenced QoL significantly. Children with moderate to severe chronic graft-versus-host disease or cognitive deficits had lower QoL in some dimensions. No correlation was, however, found between the physician-rated total late effects score and overall QoL. Contrarily, QoL was clearly related to the degree of self-rated symptoms.

Section: Discussionmentioning

confidence: 83%

Quality of life and health in children following allogeneic SCT

Forinder

Löf

Winiarski

2005

“…Intrathecal methotrexate, given alone or in combination with radiotherapy, has been closely associated with cerebral leukoencephalopathy, 23 especially in the pediatric population. 24 However, such risk is limited to 5% if systemic methotrexate is not administered. 25 Although spinal myelopathy has been observed following intrathecal methotrexate and/or cytarabine with craniospinal irradiation in children, 26 this experience is very limited and no formal association has been rigorously established.…”

Section: Discussionmentioning

confidence: 99%

Radiation myelitis following allogeneic stem cell transplantation and consolidation radiotherapy for non-Hodgkin's lymphoma

Schwartz

Schechter

Seltzer

et al. 2000

Summary:Myelitis is a rare but well documented complication of therapeutic radiation exposure to the spinal cord and is characterized by delayed development of paresthesias, sensory changes and, in severe cases, progressive paresis and paralysis. Although accepted radiation tolerance limits for the spinal cord have successfully limited the incidence of this problem (45-50 Gy, in daily 1.8-2 Gy fractions), aggressive systemic therapy may render patients more susceptible to radiation-related neurotoxicity. We describe the case of a 38-year-old man with refractory non-Hodgkin's lymphoma who underwent matched sibling peripheral blood stem cell transplant following a conditioning regimen of cyclophosphamide (60 mg/kg × 2) and total body irradiation (120 cGy × 11). This was followed by delivery of 30.6 Gy involved-field radiation at 1.8 Gy/day to the mediastinum and left supraclavicular fossa for bulky residual tumor. Although maximum cumulative radiation dose to the spinal cord was less than 45 Gy, the patient subsequently developed progressive lower extremity weakness and MRI abnormalities of the spinal cord limited to the radiation field. This represents the second report in the literature of this unexpected complication, prompting a need to reexamine current guidelines for radiotherapy in the context of high-dose systemic treatment. Bone Marrow Transplantation (2000) 26, 1355-1359.

“…The effective testing time was 4-5 h per child, allocated over 1 or 2 days, according to the needs of the individual child and family. The neuropsychological examination followed essentially the same protocol as our previous follow-up study, 13,14 covering the functional domains and tests presented in Table 2. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Tests of sensory-motor and specific cognitive functions, such as executive functions and memory, were included to the extent that the developmental level of the individual child permitted; in general, a complete neuropsychological examination could be performed in children who were 6.5 years or older at the time of assessment.…”

Section: Methodsmentioning

confidence: 99%

“…12 Our own longitudinal study of children treated at Karolinska University Hospital Huddinge during the 1980s presented an early account of the risks associated with pretransplant conditioning involving a 2-day CY regimen and subsequent TBI of 10 Gy in a single dose. 13,14 The results indicated that TBI in one dose was associated with sensory-motor and cognitive deficits and other neurological sequelae. These typically became more pronounced over time (45 year post-therapy), and were inversely related to age at treatment.…”

Section: Introductionmentioning

confidence: 97%

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

Smedler

Winiarski

2008

Self Cite

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.