Neurocognitive Outcomes Decades After Treatment for Childhood Acute Lymphoblastic Leukemia: A Report From the St Jude Lifetime Cohort Study
Neurocognitive Outcomes Decades After Treatment for Childhood Acute Lymphoblastic Leukemia: A Report From the St Jude Lifetime Cohort Study
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DOI：
10.1200/jco.2012.48.2315
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发表时间：
2013-12-10
影响因子：
45.3
通讯作者：
Hudson, Melissa M.
中科院分区：
文献类型：
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作者：
Krull, Kevin R.;Brinkman, Tara M.;Hudson, Melissa M.
目的确定儿童急性淋巴细胞白血病（ALL）治疗后数十年的成人神经认知功能障碍的发生率、模式和预测因素。患者和方法在圣裘德儿童研究医院接受治疗的儿童ALL幸存者，诊断后10年或18岁仍存活，招募他们进行神经认知功能测试。总共有1，014名幸存者符合条件，738名（72.8%）同意参与，其中567名（76.8%）接受了评估。平均年龄为33岁;自诊断以来的平均时间为26年。对颅部放射治疗（CRT）剂量和累积化疗的数据进行病历提取。结果各神经认知领域的损害率为28.6%~ 58.9%，化疗组各领域的损害率均高于化疗组（P均<0.006）。在未接受CRT的幸存者中，地塞米松与注意力受损（相对风险[RR]，2.12; 95%CI，1.11至4.03）和执行功能受损（RR，2.42; 95%CI，1.20至4.91）相关。CRT对智力、学术和记忆功能的影响取决于诊断时的年轻年龄。执行功能问题的风险以CRT剂量依赖性方式随生存时间增加。在所有幸存者中，自我报告的行为问题从诊断开始每年增加5%（RR，1.05; 95%CI，1.01至1.09）。损害与降低教育程度和unemployees.Conclusion这项研究表明，儿童ALL的成年幸存者持续和显着的神经认知功能障碍，并保证持续监测大脑健康，以促进成功的成年发展，并检测早期发病的下降幸存者成熟。
Purpose To determine rates, patterns, and predictors of neurocognitive impairment in adults decades after treatment for childhood acute lymphoblastic leukemia (ALL).Patients and Methods Survivors of childhood ALL treated at St Jude Children's Research Hospital who were still alive at 10 or more years after diagnosis and were age 18 years were recruited for neurocognitive testing. In all, 1,014 survivors were eligible, 738 (72.8%) agreed to participate, and 567 (76.8%) of these were evaluated. Mean age was 33 years; mean time since diagnosis was 26 years. Medical record abstraction was performed for data on doses of cranial radiation therapy (CRT) and cumulative chemotherapy. Multivariable modeling was conducted and glmulti package was used to select the best model with minimum Akaike information criterion.Results Impairment rates across neurocognitive domains ranged from 28.6% to 58.9%, and those treated with chemotherapy only demonstrated increased impairment in all domains (all P values < .006). In survivors who received no CRT, dexamethasone was associated with impaired attention (relative risk [RR], 2.12; 95% CI, 1.11 to 4.03) and executive function (RR, 2.42; 95% CI, 1.20 to 4.91). The impact of CRT was dependent on young age at diagnosis for intelligence, academic, and memory functions. Risk for executive function problems increased with survival time in a CRT dose-dependent fashion. In all survivors, self-reported behavior problems increased by 5% (RR, 1.05; 95% CI, 1.01 to 1.09) with each year from diagnosis. Impairment was associated with reduced educational attainment and unemployment.Conclusion This study demonstrates persistent and significant neurocognitive impairment in adult survivors of childhood ALL and warrants ongoing monitoring of brain health to facilitate successful adult development and to detect early onset of decline as survivors mature.