Osman Amira M, Ali Amany M, Sayed Heba A, Atta Haisam, Ahmed Shimaa, Alieldin Nelly, Abdelhamed Mohamed A, Saad Khaled, Shibl Azza
Department of Pediatric Oncology and Hematological Malignancies, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
Clin Transl Oncol. 2025 Mar;27(3):1263-1273. doi: 10.1007/s12094-024-03646-7. Epub 2024 Aug 12.
Cognitive dysfunction may be one of the hazardous late effects among survivors of pediatric hematological malignancies. Our study aimed to explore cognitive performance and assess the global and regional brain volume changes in survivors of hematological malignancies.
This case-control study was conducted on 68 survivors of hematological malignancies, with a median follow-up period of 2 years (ranging from 1 to 6.2 years). Stanford-Binet Test was used for cognitive assessment. A quantitative volumetric assessment of the brain was done using the NeuroQuant Brain Magnetic Resonance. Age and sex-matched 68 children were selected as a comparison group.
Cancer survivors showed significantly lower levels of IQ and their subtests than the control group. Global brain atrophy was observed in the majority of the survivors. Many risk factors significantly affected different IQ subtests, such as radiotherapy (RTH), high cumulative doses of methotrexate (MTX), and prednisone. At the same time, low white matter volume (WMV) was observed with higher cumulative doses of MTX and anthracyclines.
Hematological malignancies have a negative impact on cognition. Neurocognitive impairment and related brain changes were evident in those who received RTH, HDMTX, or high cumulative doses of steroids.
认知功能障碍可能是小儿血液系统恶性肿瘤幸存者中有害的晚期效应之一。我们的研究旨在探讨血液系统恶性肿瘤幸存者的认知表现，并评估其全脑和局部脑容量变化。
本病例对照研究对68名血液系统恶性肿瘤幸存者进行，中位随访期为2年（范围1至6.2年）。采用斯坦福-比奈智力量表进行认知评估。使用NeuroQuant脑磁共振成像对大脑进行定量体积评估。选择年龄和性别匹配的68名儿童作为对照组。
癌症幸存者的智商及其子测试得分显著低于对照组。大多数幸存者出现全脑萎缩。许多危险因素对不同的智商子测试有显著影响，如放疗（RTH）、高累积剂量的甲氨蝶呤（MTX）和泼尼松。同时，高累积剂量的MTX和蒽环类药物会导致白质体积（WMV）降低。
血液系统恶性肿瘤对认知有负面影响。接受RTH、HDMTX或高累积剂量类固醇治疗的患者存在明显的神经认知障碍和相关脑改变。
