In:
Pediatric Blood & Cancer, Wiley, Vol. 67, No. 6 ( 2020-06)
Abstract:
The aim of the study was to assess long‐term consequences of central nervous system (CNS) prophylaxis in patients with high‐risk ALL (HR‐ALL) treated according to ALL IC‐BFM 2002 and to compare observed abnormalities in patients who underwent allogeneic hematopoietic stem cell transplantation (allo‐HSCT) with those who received only prophylactic CNS irradiation (12 Gy) and with control group. Patients and methods We studied 29 patients with HR‐ALL in CR1 after treatment according to protocol ALL IC‐BFM 2002 (14 with allo‐HSCT conditioned with fractionated total body irradiation [FTBI] and 15 without HSCT) and 16 children with newly diagnosed ALL (control group). The median time from therapy completion to evaluation was 5 years. To assess brain status, volumetric T1‐weighted sequences of magnetic resonance imaging were used. Neuropsychological assessment based on battery neuropsychological tests. Results Transplanted patients had significantly lower volumes of white and gray matter ( P = .048 and P 〈 .001) and also of subcortical structures, including the thalamus ( P 〈 .001), the hippocampus ( P = .007), the putamen ( P = .011), the globus pallidus ( P = .001), and the accumbens ( P 〈 .001). In addition, these patients had generally lower cognitive performance, especially in vocabulary ( P = .011), visuospatial ability ( P = .047), executive functions and attention ( P = .034; P = .002; P = .048), and processing speed ( P = .049 and P = .037). The thalamus volume is correlated with neuropsychological performance in verbal functions ( P 〈 .001), executive functions ( P 〈 .001 and P = .024), and processing speed ( P 〈 .001). Conclusions In pediatric patients treated for ALL, FTBI‐based preparative regimen preceding allo‐HSCT causes reduction of subcortical structure volumes and decline in cognitive performance. The observed long‐term structural and functional CNS sequelae are significantly more pronounced in transplanted HR‐ALL patients than in those treated with prophylactic CNS‐ radiotherapy only.
Type of Medium:
Online Resource
ISSN:
1545-5009
,
1545-5017
Language:
English
Publisher:
Wiley
Publication Date:
2020
detail.hit.zdb_id:
2130978-4
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