Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Pediatr Blood Cancer. 2010 Mar;54(3):429-36. doi: 10.1002/pbc.22318.
To evaluate the neuropsychological late effects amongst survivors treated on the Head Start II protocol between 1997 and 2003.
Forty-nine patients (mean age 2.9 years) diagnosed with a malignant brain tumor underwent baseline neuropsychological assessment prior to autologous hematopoietic cell transplantation (AuHCT). Twenty-six survivors were retested after 3 years of follow-up as 20 patients did not survive. Patients were evaluated for intelligence, academic achievement, receptive language, visual-motor integration (VMI), learning/memory, social-emotional and behavioral functioning based upon age at testing.
Overall intelligence and VMI at baseline were low average while verbal and non-verbal intelligence, academic achievement, and receptive vocabulary were in average range. Parents reported social-emotional and behavioral functioning within normal limits. Serial testing revealed Full Scale (FSIQ)/Mental Development Index (MDI), Verbal (VIQ), and Performance (PIQ) Intelligence to be generally stable over 3-year follow-up. Group-average analysis at follow-up demonstrated low average intelligence, academic achievement, receptive language, and VMI. Age at diagnosis was positively correlated with internalizing symptoms and visual immediate memory, while time since diagnosis was inversely correlated with FSIQ, VIQ, PIQ, reading and delayed verbal memory. Craniospinal irradiation (CSI) was avoided in two-thirds of patients.
Induction, with or without intensification using intravenous methotrexate, followed by myeloablative consolidation chemotherapy with AuHCT, may avoid or delay CSI, with possible stabilization of neuropsychological functioning, including those younger at diagnosis. Continued follow-up is necessary to determine the preservation of neuropsychological, academic, social-emotional and behavioral functioning.
评估 1997 年至 2003 年期间接受 Head Start II 方案治疗的幸存者的神经认知晚期效应。
49 名（平均年龄 2.9 岁）被诊断患有恶性脑肿瘤的患者在自体造血细胞移植（AuHCT）前进行基线神经心理学评估。26 名幸存者在 3 年随访后接受了重新测试，因为 20 名患者未存活。根据测试时的年龄，对患者进行智力、学业成就、接受性语言、视觉-运动整合（VMI）、学习/记忆、社会情感和行为功能的评估。
基线时总体智力和 VMI 处于平均水平以下，而言语和非言语智力、学业成就和接受性词汇量处于平均水平。父母报告社会情感和行为功能正常。连续测试显示全量表（FSIQ）/心理发育指数（MDI）、言语（VIQ）和表现（PIQ）智力在 3 年随访期间基本稳定。随访时的组平均分析表明智力、学业成就、接受性语言和 VMI 处于平均水平以下。诊断时的年龄与内化症状和视觉即时记忆呈正相关，而诊断后的时间与 FSIQ、VIQ、PIQ、阅读和延迟言语记忆呈负相关。在三分之二的患者中避免了颅脊髓照射（CSI）。
采用静脉注射甲氨蝶呤进行诱导，或不进行强化治疗，然后采用 AuHCT 进行骨髓清除性巩固化疗，可能避免或延迟 CSI，同时可能稳定神经认知功能，包括那些在诊断时年龄较小的患者。需要继续随访以确定神经认知、学业、社会情感和行为功能的保留情况。
