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Pediatric Transplants

Neuropsychological outcome in very young hematopoietic SCT recipients in relation to pretransplant conditioning

Abstract

Stem cell transplantation involves conditioning with TBI and/or intensive chemotherapy, which may cause long-term neuropsychological deficits, particularly in children treated at a very young age. The aim of this study was to investigate whether very young children who receive chemotherapy-based conditioning only (BUCY) may have a more favorable neuropsychological outcome than children conditioned with TBI-CY. Twenty-two children who underwent allogeneic SCT at 0.4–3.6 years of age were subject to an extensive neuropsychological assessment at an average of 6.5 years post-therapy. The test results of 10 children exposed to BU were compared to the results of 12 children who had received TBI. Ten of them had received single-dose TBI, whereas two had received fractionated TBI. The BU group performed at age level on verbal measures, but tended to score below age level in the executive and visuo-spatial domains (P<0.01). By comparison, children treated with TBI had more pervasive neuropsychological impairments, including motor deficits (P<0.01) and varying degrees of perceptual (P<0.05), executive and cognitive (P<0.05) problems. In conclusion, children transplanted at a very young age had a more favorable neuropsychological development if conditioned with BUCY than if conditioned with single-dose TBI-CY.

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Acknowledgements

We gratefully acknowledge financial support from the Swedish Children's Cancer Foundation (Grant BCF 03/071).

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Correspondence to A-C Smedler.

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Smedler, AC., Winiarski, J. Neuropsychological outcome in very young hematopoietic SCT recipients in relation to pretransplant conditioning. Bone Marrow Transplant 42, 515–522 (2008). https://doi.org/10.1038/bmt.2008.217

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Keywords

  • pediatric SCT
  • cognitive functioning
  • BU
  • TBI
  • late effects

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