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Progressive Declines in Neurocognitive Function Among Survivors of Hematopoietic Stem Cell Transplantation for Pediatric Hematologic Malignancies

Shah, Ami J. MD* † ‡; Epport, Karen PhD§; Azen, Colleen PhD§; Killen, Renna RN*; Wilson, Kathy RN*; De Clerck, Dominique RN*; Crooks, Gay MD* † ‡; Kapoor, Neena MD* † ‡; Kohn, Donald B. MD* † ‡; Parkman, Robertson MD* † ‡; Weinberg, Kenneth I. MD

Journal of Pediatric Hematology/Oncology: June 2008 - Volume 30 - Issue 6 - p 411-418
doi: 10.1097/MPH.0b013e318168e750
Original Articles

Neurocognitive function of pediatric patients is of great concern after hematopoietic stem cell transplantation (HSCT). We evaluated the neurocognitive function of pediatric patients pre-HSCT, 1, 3, and 5 years post-HSCT. All patients had a hematologic malignancy and received therapy to their central nervous system. Healthy siblings were tested as a comparison group. Pediatric patients with a hematologic malignancy did not have a significant decrease in their cognitive function before HSCT compared with their siblings except in areas of academic achievement. Our study population had significant declines in visual motor skills and memory test scores within the first year post-HSCT. By 3 years post-HSCT, there was an improvement in the visual motor development scores and memory scores, but there were new deficits in verbal skills. By 5 years post-HSCT, there were progressive declines in verbal skills (P=0.005), performance skills (0.04), and new deficits seen in long-term verbal memory scores (0.04). On the basis of the raw scores, most of these tests showed that patients had an inability to acquire new skills at a rate comparable to their age-matched healthy peers. However, long-term memory scores showed definite declines. The greatest decline in neurocognitive function occurred in those patients who received cranial irradiation either as part of their initial therapy or as part of their HSCT conditioning. Pediatric patients who received HSCT for hematologic malignancies have neurocognitive deficiencies that are both acute and chronic. Although some patients have acute deficits that appear and improve over time, other patients have progressive declines in neurocognitive function that are chronic.

*Department of Pediatrics, Division of Research Immunology/Bone Marrow Transplantation

Department of Pediatrics, Keck School of Medicine

Department of Pediatrics, The Saban Research Institute

§Department of Pediatrics, General Clinical Research Center, Childrens Hospital, Los Angeles

Department of Pediatrics, Stanford University, Palo Alto, CA

Supported in part by the National Institute of Health NCRR General Clinical Research Center (GCRC) grant MO1 RR00043.

Reprints: Dr Ami J. Shah, MD, Division of Research Immunology/Bone Marrow Transplantation, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, MS no. 62, Los Angeles, CA 90027 (e-mail:

Received for publication June 2, 2006; accepted January 6, 2008

Computational assistance was provided by the National institutes of Health NCRR GCRC MO1 RR00043, CDMAS Project and was performed at the GCRC at Childrens Hospital Los Angeles.

© 2008 Lippincott Williams & Wilkins, Inc.