Mulhern R K, Wasserman A L, Fairclough D, Ochs J
Department of Child Health Sciences, St. Jude Children's Research Hospital, Memphis, TN 38101.
J Clin Oncol. 1988 Feb;6(2):315-20. doi: 10.1200/JCO.1988.6.2.315.
Previous studies have found that CNS prophylaxis of children with leukemia, especially young children receiving cranial irradiation, causes neuropsychologic deficits. In the present study, 40 children in continuous complete remission from acute lymphocytic leukemia (ALL) were given a battery of tests to assess memory functioning 5 years after CNS prophylaxis. All children were free of CNS disease at diagnosis and had been randomly assigned to receive CNS prophylaxis with either 1,800 cGy cranial irradiation (CRT) plus intrathecal (IT) methotrexate (MTX) or IT MTX plus intravenous (IV) high-dose MTX (HDMTX). No treatment- or age-related differences were seen on 16 standardized memory measures. However, scores of the combined sample were significantly lower than age-corrected norms on a test of visual-spatial memory and on four scales of verbal memory. Differences in methods or intensity of CNS prophylaxis and study group selection criteria are proposed to explain our findings and to resolve discrepancies with previous reports. The long-term neuropsychological sequelae in these survivors of ALL may be attributable to some common factor, such as the disease itself or systemic and IT chemotherapy.
以往研究发现，白血病患儿的中枢神经系统预防性治疗，尤其是接受颅脑照射的幼儿，会导致神经心理缺陷。在本研究中，对40名急性淋巴细胞白血病（ALL）持续完全缓解的患儿在进行中枢神经系统预防性治疗5年后进行了一系列测试，以评估其记忆功能。所有患儿在诊断时均无中枢神经系统疾病，并且已被随机分配接受以下两种中枢神经系统预防性治疗方案之一：1800厘戈瑞的颅脑照射（CRT）加鞘内注射（IT）甲氨蝶呤（MTX），或IT MTX加静脉注射（IV）高剂量MTX（HDMTX）。在16项标准化记忆测试中未发现与治疗或年龄相关的差异。然而，在视觉空间记忆测试和四项言语记忆量表上，综合样本的得分显著低于年龄校正后的常模。文中提出中枢神经系统预防性治疗的方法或强度以及研究组选择标准的差异，以解释我们的研究结果并解决与先前报告的差异。这些ALL幸存者的长期神经心理后遗症可能归因于某些共同因素，如疾病本身或全身及鞘内化疗。
