PEDIATRICS Vol. 90 No. 3 September 1992, pp. 447-450
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A Prospective Study of Cognitive Functioning Following Low-Dose Cranial Radiation for Bone Marrow Transplantation

Joel H. Kramer PsyD1, Mary R. Crittenden PhD1, Francine E. Halberg MD1, William M. Wara MD1, and Mortan J. Cowan MD1

1 From the University of California, San Francisco Medical Center

This study prospectively examined the effects of low doses of cranial irradiation on psychological development in children. The subjects were 22 children receiving bone marrow transplantation. Fifteen children receiving cranial doses ranging from 350 to 1200 cGy as part of their conditioning regimen were contrasted to seven children who were not irradiated. Measures of intellectual and psychosocial development were administered to all subjects prior to transplant and again at one-year posttransplant. There were no decrements in psychological functioning at the one-year follow-up, regardless of the dose of cranial radiation received or the age at which radiation was administered. In addition, there were no significant differences in test scores relative to baseline in a smaller cohort of children followed up for 3 years. Although no significant between-group findings were found, examination of individual cases revealed a high degree of variability, with decrements in IQ of 10 points or more found in 7 children at the one-year follow-up. Findings suggest that doses less than 1500 cGy may prove to be relatively well tolerated with respect to long-term cognitive and psychosocial development, even in young children, although caution is urged in light of the limited length of follow-up.

Key Words: cranial radiation • cognitive functioning • bone marrow transplant • acute lymphoblastic leukemia • severe combined immunodeficiency disease

Submitted on December 30, 1991
Accepted on March 30, 1992




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