Cognitive and academic functioning in survivors of pediatric bone marrow transplantation

Purpose: To evaluate cognitive and academic functioning in survivors of ped iatric bone marrow transplants (BMTs) at 1 and 3 years after a BMT. Patients and Methods: In a prospective, longitudinal design, patients under went a comprehensive battery of neurocognitive measures before admission fo r transplantation and at 1, 3, and 5 years after a BMT, This article descri bes a cohort of 102 survivors with follow-up data available for 1 year afte r a BMT, including 54 survivors with follow-up available for 3 years. This represents the largest cohort of pediatric BMT survivors yet reported in a prospective study. Results: In the cohort as a whole, there were no significant changes on glo bal measures of intelligence (intelligence quotient [IQ]) and academic achi evement at either 1 or 3 years after a BMT, despite adequate power to detec t an IQ change of three points or greater, Likewise, performance on specifi c tests of neuropsychologic function remained stable. No significant differ ences were observed between patients whose conditioning regimen included to tal-body irradiation (TBI) and those whose did not, The primary predictor o f neurocognitive outcome was patient age, with younger patients more likely to show declines over time. The subset of patients who were less than 3 ye ars of age at the time of transplantation seemed to be particularly vulnera ble to cognitive sequelae, Conclusion: The use of BMTs with or without TBI entails minimal risk of lat e neurocognitive sequelae in patients who are 6 years of age or older at th e time of transplantation. However, patients who are less than 6 years of a ge at the time of transplantation, and particularly those less than 3 years of age, seem to be at some risk of cognitive declines, J Clin Oncol 18:100 4-1011, (C) 2000 by American Society of Clinical Oncology.