Cognitive and Academic Consequences of Stem-Cell Transplantation in Children
- 20 April 2008
- journal article
- pediatric oncology
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 26 (12), 2027-2033
- https://doi.org/10.1200/jco.2007.13.6135
Abstract
Purpose: To describe cognitive and academic outcomes in survivors after pediatric stem-cell transplantation (SCT) through 5-years post-SCT. Patients and Methods: A battery of neurocognitive measures were administered before admission and at 1, 3, and 5 years post-SCT for 268 patients who underwent SCT; the study sample is comprised of 158 patients who survived and were evaluated at 1-year post-SCT. Random coefficient models were generated to depict change over time, and to test differences in slope and intercept for medical and demographic predictor variables. Results: In the cohort as a whole, no significant changes were seen in global intelligence quotient and academic achievement. Despite the overall stability, some significant differences in slopes were found based on diagnosis, type of transplantation, use of total-body irradiation (TBI), and presence of graft-versus-host disease (GVHD). However, these differences were small, and of limited clinical significance. In comparison, differences as a function of socioeconomic status (SES) were much larger. SES was a significant determinant of all cognitive and academic outcomes, and the effect size generally dwarfed that of other significant predictor variables. Age, which had previously been identified as an important determinant of outcome, was not significantly predictive of outcome in this cohort. Conclusion: The procedure of SCT entails minimal risk of late cognitive and academic sequelae. Subgroups of patients are at relatively higher risk: patients undergoing unrelated donor transplantation, receiving TBI, and those who experience GVHD. However, these differences are small relative to differences in premorbid functioning, particularly those associated with SES.Keywords
This publication has 26 references indexed in Scilit:
- Neuropsychological Functioning in Preschool-age Children with Sickle Cell Disease: The Role of Illness-related and Psychosocial FactorsChild Neuropsychology, 2007
- Double Burden of Iron Deficiency in Infancy and Low Socioeconomic StatusArchives of Pediatrics & Adolescent Medicine, 2006
- The Brain Reserve Hypothesis, Brain Atrophy and AgingGerontology, 2006
- Brain reserve and cognitive decline: a non-parametric systematic reviewPsychological Medicine, 2006
- Neurocognitive Consequences of Risk-Adapted Therapy for Childhood MedulloblastomaJournal of Clinical Oncology, 2005
- Cognitive and psychosocial functioning of pediatric hematopoietic stem cell transplant patients: A prospective longitudinal studyBone Marrow Transplantation, 2002
- Cognitive and adaptive behavior 1 and 3 years following bone marrow transplantationBone Marrow Transplantation, 1997
- Toxicities of total-body irradiation for pediatric bone marrow transplantationInternational Journal of Radiation Oncology*Biology*Physics, 1996
- Efficacy and toxicity of radiation in preparative regimens for pediatric stem cell transplantation. I: Clinical applications and therapeutic effectsMedical Oncology, 1995
- Long-term neurobehavioral outcome in pediatric brain-tumor patients: Review and methodological critiqueJournal of Clinical and Experimental Neuropsychology, 1994