Çocukluk çağı akut lenfoblastik lösemi sağaltımının santral sinir sistemine geç etkilerinin araştırılması
Küçük Resim Yok
Tarih
1997
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/closedAccess
Özet
ÖZET Yaşayan akut lenfoblastik lösemili (ALL) çocuklarda rıöropsikolojik, nöroradyolojik sonuçlar geniş olarak araştırılmaktadır. 1987-1993 yılları arasında ALL tanısı alarak en az 5 yıldır izlenen, tanıda 3-12 yaşlarında olan 19 hastada (15 erkek, 4 kız) sistemik kemoîerapi (0/YDMTX ) ve santral sinir sistemi korumasının (K-RT ve İT-MTX) nörotoksisitesi araştırıldı. Hastaların hepsi 1 yıl önce sağaltımı tamamlanmış ve remisyonda idi. Nöropsikolojik testler (Denver, VVISC-R, WAIS-R), kraniyai manyetik rezonans görüntüleme (MRG) ve nöroelektrofizyolojik olarak beyin sapı uyarılmış potansiyel testleri (VEP, AEP) uygulandı. Ondokuz ALL'li çocuğun performans IQ puanı (ort. 94±16.8) ve toplam IQ puanı (92.2±16.5), 17 sağlıklı kardeşten oluşan kontrol grubuna göre anlamlı olarak düşük (112.1+18.9 ve 105.4+14.2) bulundu (p=0.007) ve p=0.02). MRG 18 hastada değerlendirildi ve 6'sında (%33.3) patoloji gözlendi. Dördü (% 22.2) lökoansefalopati, 1'i (%5.5) mineralizan mikroanjiopati, 1 (%5.5) kortikal atrofi olarak değerlendirildi. Onsekiz hastanın 3'ünde (%16.6) AEP, 17 hastanın 5'inde (%29.5) VEP anormalliği vardı. ALL'li çocukların tanı yaşı (5 yaş altı ve üstü), K-RT dozu (12-18, 24 Gy), sistemik 0/YDMTX uygulaması ve SSS tutulumunun MRG patolojisine, kognitif fonksiyon bozukluklarına ve elektrofizyoiojik anormalliklere anlamiı etkisi bulunmadı. Sonuçta çok sayıda hastayı içeren çalışmalarla daha belirleyici sonuçların verilebileceği düşünüldü. 35
SUMMARY Neuroscychologic and neuroradioiogic evaluations of leukemia survivors have recently been studying extensively. We aimed to study neurotoxicity of either systemic chemotherapy (M/HDMTX) or CNS prophylaxis (Cranial RT and IT-MTX) in 19 patients with ALL who were followed-up at least 5 years after diagnosis at Ege University Medical Faculty, Department of Pediatric Hematology-Oncology between 1987 and 1993. The patients aged 3-12 years at diagnosis and there were 15 male and 4 female. All patients had completed leukemia therapy a year ago and were in remission. Neuropscychoiogic tests (Denver, WISC-R, WAIS-R), cranial magnetic resonance imaging (MRI) were done and brain stem evoked potentials (VEP, AEP) were recorded. Performance and total IQ scores of 19 patients (mean 94±16.8 and 92.2±16.5, respectively), were significantly low as compared to the controls consisted of 17 siblings (mean 112.1±18.9 and 105.4+14.2, respectively) (p=0.007) ve p=0.02). MRI was done in 18 patients of which 6 (33.3 %) had abnormal findings. Four had leukoencephalopathy (22.2 %) and the others had mineralizing microangiopathy and cortical atrophy each (5.5 %). Three out of 18 (16.6%) patients had abnormal AEP findings while 5 out of 17 (29.5%) patients displayed abnormal VEP responses. 36Abnormal findings in MRI, cognitive examination and electrophysiologic testing were not found to be associated with age at diagnosis (below or above 5 years), doses of cranial RT (12-18, 24 Gy), systemic M/HDMTX administration or CNS involvement, in conclusion data involving more patients are needed to demonstrate discrete outcomes of neurotoxicity in long-term survivors of childhood leukemia. 37
SUMMARY Neuroscychologic and neuroradioiogic evaluations of leukemia survivors have recently been studying extensively. We aimed to study neurotoxicity of either systemic chemotherapy (M/HDMTX) or CNS prophylaxis (Cranial RT and IT-MTX) in 19 patients with ALL who were followed-up at least 5 years after diagnosis at Ege University Medical Faculty, Department of Pediatric Hematology-Oncology between 1987 and 1993. The patients aged 3-12 years at diagnosis and there were 15 male and 4 female. All patients had completed leukemia therapy a year ago and were in remission. Neuropscychoiogic tests (Denver, WISC-R, WAIS-R), cranial magnetic resonance imaging (MRI) were done and brain stem evoked potentials (VEP, AEP) were recorded. Performance and total IQ scores of 19 patients (mean 94±16.8 and 92.2±16.5, respectively), were significantly low as compared to the controls consisted of 17 siblings (mean 112.1±18.9 and 105.4+14.2, respectively) (p=0.007) ve p=0.02). MRI was done in 18 patients of which 6 (33.3 %) had abnormal findings. Four had leukoencephalopathy (22.2 %) and the others had mineralizing microangiopathy and cortical atrophy each (5.5 %). Three out of 18 (16.6%) patients had abnormal AEP findings while 5 out of 17 (29.5%) patients displayed abnormal VEP responses. 36Abnormal findings in MRI, cognitive examination and electrophysiologic testing were not found to be associated with age at diagnosis (below or above 5 years), doses of cranial RT (12-18, 24 Gy), systemic M/HDMTX administration or CNS involvement, in conclusion data involving more patients are needed to demonstrate discrete outcomes of neurotoxicity in long-term survivors of childhood leukemia. 37
Açıklama
Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.
Anahtar Kelimeler
Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, Merkez sinir sistemi, Central nervous system, Prekürsör hücreli lenfoblastik lösemi-lenfoma, Precursor cell lymphoblastic leukemia-lymphoma
