Sleurs Charlotte, Lemiere Jurgen, Vercruysse Trui, Nolf Nathalie, Van Calster Ben, Deprez Sabine, Renard Marleen, Vandecruys Els, Benoit Yves, Uyttebroeck Anne
University Hospitals Leuven, Department of Pediatric Hematology and Oncology, Leuven, Belgium.
KU Leuven, Department of Development and Regeneration, Leuven, Belgium.
Psychooncology. 2017 Apr;26(4):508-514. doi: 10.1002/pon.4186. Epub 2016 Jun 20.
In childhood acute lymphoblastic leukemia (ALL), radiotherapy for CNS prophylaxis is not used in frontline therapy anymore. Standard treatment for ALL nowadays consists of polychemotherapy. Therefore, assessment of potential chemotherapy-induced cognitive side effects becomes important. Although neurotoxicity was demonstrated in cross-sectional studies, longitudinal studies remain scarce.
We evaluated intellectual development of 94 pediatric ALL patients between 1990 and 1997, diagnosed before the age of 12 years, treated according to the European Organisation for Research and Treatment of Cancer Children's Leukemia Group 58881 protocol. Three assessments of the Wechsler Intelligence Scale for Children Revised were performed since diagnosis, according to age. Using repeated measures regression analysis, we investigated the effect of gender (low versus increased) risk group, parents' education, age at diagnosis, intelligence quotient (IQ) subscale (verbal (VIQ) versus performance (PIQ) intelligence), and test session.
PIQ scores were lower than VIQ at baseline (-5.3 points on average, p = 0.0032), yet PIQ increased more strongly (PIQ: +3.9 points per test session; VIQ: +0.8, p = 0.0079), so this baseline difference disappeared (p = 0.0079). There were no clear effects of gender (girls: +0.6 points; p = 0.78) or risk group (low risk: +1.5 points; p = 0.49), but IQ scores were higher when one parent had followed higher education (+9.5 points, p < 0.0001). Finally, diagnosis at younger age predicted lower IQ scores (-1.3 points per year, p = 0.0009).
Given that IQ scores did not decline, our findings demonstrate a stable pattern. However, the lower PIQ scores at baseline may indicate that performance functioning is vulnerable to acute neurotoxicity. Also, lower scores for younger patients highlight the stronger impact of the disease and/or treatment at younger age.Copyright © 2016 John Wiley & Sons, Ltd.
在儿童急性淋巴细胞白血病（ALL）中，中枢神经系统预防性放疗不再用于一线治疗。如今ALL的标准治疗包括多药化疗。因此，评估潜在的化疗引起的认知副作用变得很重要。尽管在横断面研究中已证实存在神经毒性，但纵向研究仍然很少。
我们评估了1990年至1997年间94例12岁前确诊的小儿ALL患者的智力发育情况，这些患者按照欧洲癌症研究与治疗组织儿童白血病组58881方案进行治疗。自确诊以来，根据年龄对韦氏儿童智力量表修订版进行了三次评估。我们使用重复测量回归分析，研究了性别（低风险与高风险）、风险组、父母教育程度、确诊年龄、智商子量表（言语智商（VIQ）与操作智商（PIQ））以及测试时间的影响。
基线时PIQ得分低于VIQ（平均低5.3分，p = 0.0032），但PIQ增长更强（PIQ：每次测试增长3.9分；VIQ：增长0.8分，p = 0.0079），因此这种基线差异消失了（p = 0.0079）。性别（女孩：增长0.6分；p = 0.78）或风险组（低风险：增长1.5分；p = 0.49）没有明显影响，但父母中有一人接受过高等教育时智商得分更高（高9.5分，p < 0.0001）。最后，确诊年龄越小，智商得分越低（每年低1.3分，p = 0.0009）。
鉴于智商得分没有下降，我们的研究结果显示出一种稳定的模式。然而，基线时较低的PIQ得分可能表明操作功能易受急性神经毒性影响。此外，年轻患者得分较低突出了疾病和/或治疗在年轻时的更强影响。版权所有© 2016约翰威立父子有限公司。
