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Cognitive and Academic Consequences of Stem-Cell Transplantation in Children

Sean Phipps, Shesh N. Rai, Wing-Hang Leung, Shelly Lensing, Maggi Dunavant

From the Division of Behavioral Medicine; Department of Biostatistics; and the Division of Stem Cell Transplant, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN

Corresponding author: Sean Phipps, PhD, Division of Behavioral Medicine, St Jude Children's Research Hospital, 332 N Lauderdale, Memphis, TN 38105-2794; e-mail: sean.phipps{at}stjude.org

Purpose To describe cognitive and academic outcomes in survivors after pediatric stem-cell transplantation (SCT) through 5-years post-SCT.

Patients and Methods A battery of neurocognitive measures were administered before admission and at 1, 3, and 5 years post-SCT for 268 patients who underwent SCT; the study sample is comprised of 158 patients who survived and were evaluated at 1-year post-SCT. Random coefficient models were generated to depict change over time, and to test differences in slope and intercept for medical and demographic predictor variables.

Results In the cohort as a whole, no significant changes were seen in global intelligence quotient and academic achievement. Despite the overall stability, some significant differences in slopes were found based on diagnosis, type of transplantation, use of total-body irradiation (TBI), and presence of graft-versus-host disease (GVHD). However, these differences were small, and of limited clinical significance. In comparison, differences as a function of socioeconomic status (SES) were much larger. SES was a significant determinant of all cognitive and academic outcomes, and the effect size generally dwarfed that of other significant predictor variables. Age, which had previously been identified as an important determinant of outcome, was not significantly predictive of outcome in this cohort.

Conclusion The procedure of SCT entails minimal risk of late cognitive and academic sequelae. Subgroups of patients are at relatively higher risk: patients undergoing unrelated donor transplantation, receiving TBI, and those who experience GVHD. However, these differences are small relative to differences in premorbid functioning, particularly those associated with SES.

Supported in part by a Grant No. CA60616 from the National Cancer Institute, and by the American Lebanese-Syrian Associated Charities.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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