title: Total body irradiation: a neuropsychological risk factor in pediatric bone marrow transplant recipients.
abstract: 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.
authors.affiliation: Department of Psychology, Stockholm University, Sweden.
authors.forename: A C
authors.initials: AC
authors.lastname: Smedler
authors.forename: C
authors.initials: C
authors.lastname: Nilsson
authors.forename: P
authors.initials: P
authors.lastname: Bolme
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000741:Anemia, Aplastic / Q000532:radiotherapy / Q000628:therapy; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control; D006801:Humans; D007278:Injections, Spinal; D007938:Leukemia / Q000532:radiotherapy / Q000628:therapy; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008727:Methotrexate / Q000008:administration & dosage; D009422:Nervous System Diseases / Q000209:etiology*; D009483:Neuropsychological Tests; D011829:Radiation Dosage; D012307:Risk Factors; D013997:Time Factors; D014916:Whole-Body Irradiation
chemical_list: D003520:Cyclophosphamide; D008727:Methotrexate