Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle Children's Hospital, 4600 Sand Point Way NE, Seattle, WA, 98105, USA.
Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA.
J Cancer Surviv. 2022 Jun;16(3):696-704. doi: 10.1007/s11764-021-01063-1. Epub 2021 Jun 4.
Pediatric patients who undergo hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can impact quality of life. Given limited long-term studies, we aimed to characterize the late neurocognitive outcomes in a cohort of pediatric HCT survivors.
Eligible survivors (HCT at age < 21 year and ≥ 1 year post-HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) and the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL). Analyses of risk factors included univariate comparisons and multivariable logistic regression.
Participants (n = 199, 50.3% female, 53.3% acute leukemia, 87.9% allogeneic transplants) were surveyed at median age of 37.8 years (interquartile range [IQR] 28.5-48.8) at survey and median 27.6 years (IQR 17.0-34.0) from transplant. On the CCSS-NCQ, 18.9-32.5% of survivors reported impairments (Z score > 1.28) in task efficiency, memory, emotional regulation, or organization, compared with expected 10% in the general population (all p < 0.01). In contrast, survivors reported average Neuro-QoL (T score 49.6±0.7) compared with population normative value of 50 (p = 0.52). In multivariable regression, impaired Neuro-QoL (T score < 40) was independently associated with hearing issues (OR 4.97, 95% CI 1.96-12.6), history of stroke or seizure (OR 4.46, 95% CI 1.44-13.8), and sleep disturbances (OR 6.95, 95% CI 2.53-19.1).
Although long-term survivors of pediatric HCT reported higher rates of impairment in specific neurocognitive domains, cognitive quality of life was perceived as similar to the general population. Subsets of survivors with certain co-morbidities had substantially worse neurocognitive outcomes.
While the long-term impact of pediatric HCT can include neurocognitive deficits, survivors report average cognitive quality of life.
接受造血细胞移植（HCT）的儿科患者存在神经认知障碍的风险，这可能会影响生活质量。鉴于长期研究有限，我们旨在描述一组儿科 HCT 幸存者的晚期神经认知结果。
符合条件的幸存者（HCT 时年龄<21 岁且>HCT 后 1 年）完成了一项关于神经认知功能和生活质量的 60 个问题的调查，其中包括儿童癌症幸存者研究神经认知问卷（CCSS-NCQ）和神经生活质量认知功能简短量表（Neuro-QoL）。风险因素分析包括单变量比较和多变量逻辑回归。
参与者（n=199，50.3%为女性，53.3%为急性白血病，87.9%为异基因移植）在调查时的中位年龄为 37.8 岁（四分位距 [IQR] 28.5-48.8），自移植起的中位年龄为 27.6 岁（IQR 17.0-34.0）。在 CCSS-NCQ 上，18.9-32.5%的幸存者报告在任务效率、记忆、情绪调节或组织方面存在障碍（Z 分数>1.28），而一般人群中预期的比例为 10%（均 p<0.01）。相比之下，幸存者报告的平均神经生活质量（T 分数 49.6±0.7）与人群正常值 50 相似（p=0.52）。在多变量回归中，神经生活质量受损（T 分数<40）与听力问题（OR 4.97，95%CI 1.96-12.6）、中风或癫痫发作史（OR 4.46，95%CI 1.44-13.8）和睡眠障碍（OR 6.95，95%CI 2.53-19.1）独立相关。
尽管儿科 HCT 的长期幸存者报告在特定神经认知领域存在更高的障碍发生率，但他们认为认知生活质量与一般人群相似。某些合并症幸存者亚组的神经认知结果明显更差。
虽然儿科 HCT 的长期影响可能包括神经认知缺陷，但幸存者报告的认知生活质量平均水平。
