Smedler A-C, Winiarski J
Department of Psychology, Stockholm University, Stockholm, Sweden.
Bone Marrow Transplant. 2008 Oct;42(8):515-22. doi: 10.1038/bmt.2008.217. Epub 2008 Aug 4.
Stem cell transplantation involves conditioning with TBI and/or intensive chemotherapy, which may cause long-term 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 (P<0.01). By comparison, children treated with TBI had more pervasive neuropsychological impairments, including motor deficits (P<0.01) and varying degrees of perceptual (P<0.05), executive and cognitive (P<0.05) 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.
干细胞移植涉及采用全脑照射和/或强化化疗进行预处理，这可能会导致长期的神经心理缺陷，尤其是在极年幼时接受治疗的儿童中。本研究的目的是调查仅接受基于化疗的预处理（BUCY）的极年幼儿童是否比接受全脑照射-环磷酰胺（TBI-CY）预处理的儿童具有更有利的神经心理结果。22名在0.4至3.6岁接受异基因造血干细胞移植的儿童在治疗后平均6.5岁时接受了广泛的神经心理评估。将10名接受BUCY预处理儿童的测试结果与12名接受全脑照射儿童的结果进行比较。其中10名接受了单剂量全脑照射，而2名接受了分次全脑照射。BUCY组在语言测试中达到年龄水平，但在执行和视觉空间领域的得分往往低于年龄水平（P<0.01）。相比之下，接受全脑照射治疗的儿童存在更普遍的神经心理损伤，包括运动缺陷（P<0.01）以及不同程度的感知（P<0.05）、执行和认知（P<0.05）问题。总之，极年幼时接受移植的儿童，如果采用BUCY预处理，其神经心理发育比采用单剂量TBI-CY预处理更为有利。
