Smedler A C, Nilsson C, Bolme P
Department of Psychology, Stockholm University, Sweden.
Acta Paediatr. 1995 Mar;84(3):325-30. doi: 10.1111/j.1651-2227.1995.tb13637.x.
Bone marrow transplantation (BMT) involves conditioning with cyclophosphamide and, for leukemic patients, total body irradiation (TBI). Based on the concern that this may lead to later neuropsychologic impairment in children, a longitudinal study was conducted. Thirty pediatric bone marrow transplant recipients, treated for leukemia or severe aplastic anemia (SAA), and their sibling donors, were given a neuropsychological examination in 1986 and 1988. A third follow-up study of patients treated before 12 years of age was undertaken in 1990-91. We present longitudinal data on patients treated with BMT when 3-11 (n = 15) and 12-17 (n = 11) years old. No neuropsychological deficits were found in the older group, or among non-irradiated SAA patients. In the first follow-up, children treated with BMT, including TBI at 3-11 years of age, performed less well than donors on tasks involving perceptual and fine-motor speed. In the second follow-up, this group of patients also demonstrated a slight deficit in non-verbal problem solving. An additional relative decline in verbal reasoning was noted in the third follow-up, 5.5-10 years after treatment. Alertness to signs of developmental difficulties in children treated with BMT, including TBI, is recommended.
骨髓移植（BMT）包括使用环磷酰胺进行预处理，对于白血病患者还需进行全身照射（TBI）。基于对这可能导致儿童后期神经心理损害的担忧，开展了一项纵向研究。30名接受白血病或重型再生障碍性贫血（SAA）治疗的儿科骨髓移植受者及其同胞供者在1986年和1988年接受了神经心理学检查。1990 - 1991年对12岁之前接受治疗的患者进行了第三次随访研究。我们呈现了3 - 11岁（n = 15）和12 - 17岁（n = 11）接受BMT治疗患者的纵向数据。在年龄较大的组或未接受照射的SAA患者中未发现神经心理学缺陷。在首次随访中，接受BMT治疗（包括3 - 11岁时接受TBI）的儿童在涉及感知和精细运动速度的任务上表现不如供者。在第二次随访中，这组患者在非语言问题解决方面也表现出轻微缺陷。在第三次随访中，即治疗后5.5 - 10年，言语推理方面出现了额外的相对下降。建议对接受包括TBI在内的BMT治疗的儿童发育困难迹象保持警惕。
