急性髓系白血病后的长期神经认知和心理社会结局：儿童癌症幸存者研究报告。
Long-Term Neurocognitive and Psychosocial Outcomes After Acute Myeloid Leukemia: A Childhood Cancer Survivor Study Report.
机构信息
Akron Children's Hospital, Akron, OH, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
出版信息
J Natl Cancer Inst. 2021 Apr 6;113(4):481-495. doi: 10.1093/jnci/djaa102.
BACKGROUND
Survivors of childhood acute myeloid leukemia (AML) are vulnerable to medical late effects of treatment; however, less is known about their psychosocial outcomes. This study evaluated neurocognitive and psychosocial outcomes in long-term AML survivors treated with bone marrow transplantation (BMT) or intensive chemotherapy (IC) without BMT.
METHODS
AML survivors (N = 482; median age at diagnosis = 8 [range = 0-20] years; median age at evaluation = 30 [range = 18-49] years) treated with BMT (n = 183) or IC (n = 299) and sibling controls (N = 3190; median age at evaluation = 32 [range = 18-58] years) from the Childhood Cancer Survivor Study were compared on emotional distress (Brief Symptom Inventory-18), neurocognitive problems (Childhood Cancer Survivor Study Neurocognitive Questionnaire), health-related quality of life (SF-36), and social attainment. Outcomes were dichotomized (impaired vs nonimpaired) using established criteria, and relative risks (RRs) were estimated with multivariable Poisson regression, adjusted for age at evaluation and sex.
RESULTS
AML survivors were more likely than siblings to report impairment in overall emotional (RR = 2.19, 95% confidence interval [CI] = 1.51 to 3.18), neurocognitive (RR = 2.03, 95% CI = 1.47 to 2.79), and physical quality of life (RR = 2.71, 95% CI = 1.61 to 4.56) outcomes. Survivors were at increased risk for lower education (RR = 1.15, 95% CI = 1.03 to 1.30), unemployment (RR = 1.41, 95% CI = 1.16 to 1.71), lower income (RR = 1.39, 95% CI = 1.17 to 1.65), and not being married or having a partner (RR = 1.33, 95% CI = 1.17 to 1.51). BMT-treated survivors did not differ statistically significantly from IC-treated on any outcome measure.
CONCLUSIONS
AML survivors are at increased risk for psychosocial impairment compared with siblings; however, BMT does not confer additional risk for psychosocial late effects compared with treatment without BMT.
背景
儿童急性髓系白血病（AML）幸存者易受到治疗的医学迟发性影响；然而，对于他们的社会心理结局知之甚少。本研究评估了接受骨髓移植（BMT）或无 BMT 的强化化疗（IC）治疗的长期 AML 幸存者的神经认知和社会心理结局。
方法
AML 幸存者（N=482；诊断时的中位年龄为 8 岁[范围为 0-20 岁]；评估时的中位年龄为 30 岁[范围为 18-49 岁]）接受 BMT（n=183）或 IC（n=299）治疗，以及来自儿童癌症幸存者研究的同胞对照组（N=3190；评估时的中位年龄为 32 岁[范围为 18-58 岁]）在情绪困扰（简明症状量表-18）、神经认知问题（儿童癌症幸存者研究神经认知问卷）、健康相关生活质量（SF-36）和社会成就方面进行了比较。使用既定标准将结局分为受损和未受损（impaired vs nonimpaired），并使用多变量泊松回归估计相对风险（RR），调整评估时的年龄和性别。
结果
与同胞相比，AML 幸存者更有可能报告总体情绪（RR=2.19，95%置信区间[CI]=1.51-3.18）、神经认知（RR=2.03，95% CI=1.47-2.79）和身体生活质量（RR=2.71，95% CI=1.61-4.56）受损。幸存者在教育程度较低（RR=1.15，95% CI=1.03-1.30）、失业（RR=1.41，95% CI=1.16-1.71）、收入较低（RR=1.39，95% CI=1.17-1.65）和未婚或无伴侣（RR=1.33，95% CI=1.17-1.51）的风险增加。与接受 IC 治疗的幸存者相比，接受 BMT 治疗的幸存者在任何结局测量上均无统计学差异。
结论
与同胞相比，AML 幸存者发生社会心理障碍的风险增加；然而，与无 BMT 的治疗相比，BMT 并不会增加社会心理迟发性影响的风险。
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