ABSTRACT

Data on the long-term neurodevelopmental outcomes of children exposed to hematological maternal cancer with or without treatment during pregnancy are lacking. A total of 57 children, of whom 33 males and 24 females, prenatally exposed to hematological malignancies and its treatment, were invited for neuropsychological and physical examinations at 18 months, 36 months, 6, 9, 12, 15 and 18 years of age. Oncological, obstetrical, neonatal and follow-up data of these children were collected. Parents were asked to complete questionnaires on their child’s general health, school performances, social situation, behavioral development, executive functioning, and if their child receives supportive care. Non-Hodgkin lymphoma was diagnosed in 35.1%, Hodgkin lymphoma in 28.1%, acute myeloid leukemia in 15.8%, chronic myeloid leukemia in 12.3%, and acute lymphoblastic leukemia in 8.8%. Cognitive development at a median age of 10.7 years was within the normal range. In subgroup analyses of children in early childhood, the gestational age at birth was correlated with the cognitive outcome at a median age of 1.7 years. Scores for language development, intelligence, attention, memory and behavior, as well as clinical neurological and general pediatric examinations were within normal ranges. In subgroup analyses, the need for supportive care in the child was associated with the loss of the mother. Prenatal exposure to hematological maternal malignancies with or without treatment did not affect the neurodevelopment of the child in the long term. Yet, caution is indicated and surveillance of the emotional development of the child is needed, especially when the mother is deceased to cancer.

摘要

缺乏关于在怀孕期间接受或未接受治疗的血液母体癌症暴露儿童的长期神经发育结果的数据。共有57名儿童，其中男性33名，女性24名，出生前暴露于血液系统恶性肿瘤及其治疗，分别在18个月、36个月、6、9、12、15和18岁时被邀请进行神经心理和体格检查。收集了这些儿童的肿瘤学、产科、新生儿和随访数据。家长被要求完成关于孩子的一般健康、学校表现、社会状况、行为发展、执行功能以及他们的孩子是否接受支持性护理的问卷。非霍奇金淋巴瘤确诊率为 35.1%，霍奇金淋巴瘤为 28.1%，急性髓系白血病为 15.8%，慢性髓系白血病为 12.3%，和 8.8% 的急性淋巴细胞白血病。中位年龄为 10.7 岁的认知发育在正常范围内。在幼儿期儿童的亚组分析中，出生胎龄与中位年龄 1.7 岁的认知结果相关。语言发展、智力、注意力、记忆力和行为以及临床神经学和一般儿科检查的分数都在正常范围内。在亚组分析中，孩子需要支持性护理与失去母亲有关。从长远来看，无论是否接受治疗，产前暴露于血液母体恶性肿瘤均不会影响儿童的神经发育。然而，需要谨慎并需要监测孩子的情绪发展，尤其是当母亲因癌症去世时。