[接受或未接受预防性中枢神经系统放疗的急性髓系白血病患儿的神经心理学后遗症]

[Neuropsychological sequelae in children with AML treated with or without prophylactic CNS-irradiation].

作者信息

Reinhardt D, Thiele C, Creutzig U

机构信息

Pädiatrische Hämatologie/Onkologie, Westfälischen-Wilhelms Universität, Münster.

出版信息

Klin Padiatr. 2002 Jan-Feb;214(1):22-9. doi: 10.1055/s-2002-19861.

DOI:10.1055/s-2002-19861

PMID:11823950

Abstract

BACKGROUND

In study AML-BFM 87 the relapse rate was lower in patients receiving cranial irradiation (CRT). However, CRT has always been associated with adverse cognitive side effects. Therefore, the impact of CRT on neuropsychological function in children with AML was retrospectively evaluated.

PATIENTS

We tested 53 children (30 boys, 23 girls) treated according to the AML-BFM-87 protocol (median age at diagnosis: 8.5 years, range 0.3 - 17.5; median time since diagnosis: 5.7 yrs, 3.8 - 10.7 yrs). To avoid any bias from additional therapy elements, patients with relapse or initial CNS involvement and transplanted patients were excluded (n=32). Our cohort was representative of the total group of 104 long term survivors of study AML-BFM 87. CNS prophylaxis consisted of ARA-C i.th., high dose ARA-C i. v. and either no CRT (n=15) or CRT (n=38) at a dose of 12 - 18 Gy depending on age.

METHODS

Neuropsychological function was evaluated by psychological tests of attention and concentration (test d2 by Brickenkamp) and an intelligence test (Progressive Matrices by Raven). In addition, patients and their parents were interviewed about the occurrence of learning problems, subjective deficits in concentration and physical impairment.

RESULTS

In the total group, no significant differences were seen between irradiated and non-irradiated patients regarding the psychological tests. However, the irradiated patients scored below the non-irradiated control group in test "d2" (concentration: 41st vs. 59th percentile). In the interview, irradiated patients tended to report more learning problems (lp) (10/36 vs. 1/14; p=0.15) and subjective deficits in concentration (con). In irradiated girls (con: 6/15 vs. 0/8; p=0.06; lp: 5/15 vs. 0/8; p=0.12) and younger patients (0 - 5 years at diagnosis; con: 7/12 vs. 2/9; p=0.18; lp 3/10 vs. 1/9; p=0.18) this trend was even more pronounced.

CONCLUSION

Children with AML and CRT had no significant intellectual impairment in standardized tests when compared to non-irradiated patients. However, more irradiated patients reported learning problems and subjective concentration deficits.

摘要

背景

在AML-BFM 87研究中，接受颅脑照射（CRT）的患者复发率较低。然而，CRT一直与不良认知副作用相关。因此，我们对CRT对急性髓系白血病（AML）患儿神经心理功能的影响进行了回顾性评估。

患者

我们测试了53名根据AML-BFM-87方案治疗的儿童（30名男孩，23名女孩）（诊断时的中位年龄：8.5岁，范围0.3 - 17.5岁；自诊断以来的中位时间：5.7年，3.8 - 10.7年）。为避免其他治疗因素产生的任何偏差，排除了复发或初始中枢神经系统受累的患者以及接受移植的患者（n = 32）。我们的队列代表了AML-BFM 87研究中104名长期存活者的总体情况。中枢神经系统预防措施包括鞘内注射阿糖胞苷、静脉注射高剂量阿糖胞苷，根据年龄，部分患者接受12 - 18 Gy的CRT（n = 38），部分患者不接受CRT（n = 15）。

方法

通过注意力和专注力心理测试（Brickenkamp的d2测试）和智力测试（Raven渐进性矩阵测试）评估神经心理功能。此外，就学习问题的发生情况、注意力主观缺陷和身体损伤情况对患者及其父母进行了访谈。

结果

在整个研究组中，接受照射和未接受照射的患者在心理测试方面没有显著差异。然而，在“d2”测试（专注力）中，接受照射的患者得分低于未接受照射的对照组（第41百分位数对第59百分位数）。在访谈中，接受照射的患者倾向于报告更多的学习问题（lp）（10/36对1/14；p = 0.15）和注意力主观缺陷（con）。在接受照射的女孩中（con：6/15对0/8；p = 0.06；lp：�/15对0/8；p = 0.12）以及年龄较小的患者中（诊断时0 - 5岁；con：7/12对2/9；p = 0.18；lp 3/10对1/9；p = 0.18），这种趋势更为明显。