Intelligence Quotient in Childhood Acute Lymphoblastic Leukemia after Prophylactic Treatment in Central Nervous System with 18 Gy Cranial Irradiation and Intrathecal Methotrexate

以18Gy顱部放射和髓鞘內注射methotrexate作爲中樞神經預防治療後之急性淋巴性白血病童的智力商數

劉希哲(Hsi-Che Liu) ； 梁德城(Der-Cherng Liang) ； 陳淑惠(Shu-Huey Chen) ； 羅秋怡(Chiu-Yi Lo) ； 曾光佩(Kuang-Pei Tseng) ； 郭翠彬(Tsuey-Bin Kuo) ； 陳秀珍(Hsiu-Jean Chen) ； 王秀枝(Shiew-Jyr Wang)

《Acta Paediatrica Sinica》 37卷2期 (1996/04) Pp. 107-110

https://doi.org/10.7097/APS.199604.0107

摘要

本研究旨在評估：兒童期急性淋巴性白血病使用顱部放射及髓鞘內注射methotrexate(MTX)作爲中樞神經預防治療後智力商數(IQ)的變化。在TCL 842治療程式中，急性淋巴性白血病病童於緩解後即接受以下中樞神經預防治療，包括：顱部放射（18Gy,分成12次）及髓鞘磪注射MTX（每次15mg/m^2，最高量15mg,共5次）。第一次的IQ測驗於緩解後便儘快進行，5年沒有復發的病童則接受第二次IQ測驗。至於測驗的方式：3至6歲的病童採用比西量表(Stanford-Binet)第四版，較大的病童則採用魏氏量表(Wechsler Intelhigence Scale for Children-Revised,WISCR)。共有14位病童進入此研究，男女各佔7位，年齡分布介於3歲至9歲之間，包括2位高危險群，8位中度危險群及4位標准危險群。結果所有病童的IQ值皆分布於正常範圍內，第一次測驗的IQ平均值爲104.29（分布於83~124之間，S.D.14.55），第二次測驗的IQ平均值爲100.93（分布於85~128之間，S.D.11.57），兩次評量的結果無統計上的差異(paired test,two-tailed P=0.4262;inc-tailed P=0.2116)。我們的結論顯示：TCL 842治療程式中使用的中樞神經預防治療或許不至於造成智力商數的減退。

關鍵字

急性淋巴性白血病 ； 中樞神經預防治療 ； 顱部放射 ； 髓鞘內注射methotrexate ； 智力商數

並列摘要

The purpose of this study is to evaluate whether central nervous system prophylactic treatment (CNSP) with cranial irradiation therapy (CrRT) 18 Gy and intrathecal methotrexate would decline the intelligence quotient (IQ) scores of children with acute lymphoblastic leukemia (ALL). In protocol TCL 842, children with ALL received CrRT 18 Gy in 12 fractions, and 5 concomitant doses of intrathecal methotrexate 15 mg/m^2/dose with 15 mg as the maximum, for CNSP after remission achieved. The first IQ test was performed immediately after CNSP. Those who had no CNS relapse for more than 5 years after CNSP had a second IQ test. For children between 3 and 6 years old, the Stanford-Binet (S-B) IV test was used, and for older children, the Wechsler Intelligence Scale for Children-Revised (WISC-R) was used. Fourteen consecutive children at our hospital were enrolled. There were 7 boys and 7 girls. The age at diagnosis ranged from 3 to 9 years old. Two of them were in the high-risk group, eight in the intermediate-risk group, and four in the standard-risk group. The IQ scores of all patients fell within the average range. In the first IQ tests, the mean IQ score was 104.29 (range 83-124, S.D. 14.55). In the second IQ tests, the mean IQ score was 100.93 (range 85-128, S.D. 11.57). Statistically, there was no significant difference between the first and second IQ scores (paired t-test, two-tailed P=0.4232; one-tailed P=0.2116). Our findings suggested that CNSP used in protocol TCL 842 did not reduce IQ scores of children with ALL 5 years after CNSP.

並列關鍵字

acute lymphoblastic leukemia ； central nervous system prophylaxis ； cranial irradiation ； intrathecal methotrexate ； intelligence quotient