Impact of Propofol Exposure on Neurocognitive Outcomes in Children With High-Risk B ALL: A Children's Oncology Group Study

作者：Sarah W. Alexander, John A. Kairalla, Sumit Gupta, Emily Hibbitts, Hannah S. Weisman, Doralina L. Anghelescu, Naomi Joan Winick, Kevin R. Krull, Wanda L. Salzer, Michael James Burke, Lia Gore, Meenakshi Devidas, Leanne M. Embry, Elizabeth A. Raetz, Stephen P. Hunger, Mignon L. Loh, Kristina K. Hardy · 发表于：Journal of Clinical Oncology · 年份：2024 · DOI：10.1200/jco.23.01989 · 被引用次数：29 · 研究领域：Anesthesia and Neurotoxicity Research、Intensive Care Unit Cognitive Disorders、Acute Lymphoblastic Leukemia research

PURPOSE Many children treated for ALL develop long-term neurocognitive impairments. Increased risk of these impairments is associated with treatment and demographic factors. Exposure to anesthesia is an additional possible risk factor. This study evaluated the impact of cumulative exposure to anesthesia on neurocognitive outcomes among a multicenter cohort of children with ALL. METHODS This study was embedded in AALL1131, a Children's Oncology Group phase III trial for patients with high-risk B-ALL. In consenting patients age 6-12 years, prospective uniform assessments of neurocognitive function were performed during and at 1 year after completion of therapy. Exposure to all episodes of anesthetic agents was abstracted. Multivariable linear regression models determined associations of cumulative anesthetic agents with the primary neurocognitive outcome reaction time/processing speed (age-normed) at 1 year off therapy, adjusting for baseline neurocognitive score, age, sex, race/ethnicity, insurance status (as a proxy for socioeconomic status), and leukemia risk group. RESULTS One hundred and forty-four children, 76 (52.8%) males, mean age of 9.1 (min-max, 6.0-12.0) years at diagnosis, underwent a median of 27 anesthetic episodes (min-max, 1-37). Almost all patients were exposed to propofol (140/144, 97.2%), with a mean cumulative dose of 112.3 mg/kg. One year after therapy, the proportion of children with impairment ( Z-score ≤–1.5) was significantly higher compared with a nor...