Uzun süreli sağkalım gösteren çocukluk çağı lösemi olgularında tedavinin nöropsikiyatrik geç etkilerinin değerlendirilmesi
Assessment of neuropsychiatric late effects among survivors of childhood leukemia
- Tez No: 310029
- Danışmanlar: PROF. DR. GÜLERSU İRKEN
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2012
- Dil: Türkçe
- Üniversite: Dokuz Eylül Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 172
Özet
Amaç: Lösemi çocukluk çağında en sık görülen kanser olup, tedavilerdeki gelişmeler sayesinde günümüzde sağkalım belirgin artmıştır. Yaşayan hastalar arttıkça tedaviye bağlı komplikasyonlar da dikkati çekmeye başlamıştır. Yan etki olarak kullanılan kemoterapotik ajanlara ve radyoterapiye bağlı büyüme ve gelişme geriliği, kardiyak toksisite, endokrinolojik, gastrointestinal, renal, solunumsal problemler, puberte bozuklukları, infertilite, osteopeni/osteoporoz, kemiklerde kırıkların yanısıra kognitif fonksiyonlarda bozukluk, nörolojik, duysal ve motor fonksiyonlarda bozukluk, psikiyatrik etkilenmeler, görme ve işitme bozuklukları, ve ikincil neoplazmların görülmektedir. Ayrıca gelişebilecek nöropsikiyatrik geç yan etkiler yaşam kalitesini olumsuz etkileyebilir. Biz bu çalışmada gelişen nöropsikiyatrik geç yan etkilerin sıklığını, ortaya çıkmasında katkısı olan faktörleri araştırmayı amaçladık.Hastalar ve yöntem: Dokuz Eylül Üniversitesi Çocuk Hematoloji Bilim Dalı'nda tedavi edilmiş olan hastalardan tanı tarihinden itibaren en az beş yıl süre geçen, Berlin?Frankfurt-Münster (BFM) protokollerine göre tedavi alan ve relaps gelişmemiş, kür olan olgular çalışmaya alındı. Olguların demografik özellikleri kaydedildi, nörolojik ve göz muayeneleri yapıldı. Kraniyal görüntülemeleri ve işitme testleri yapıldı. Psikolojik gelişim testleri ile nörokognitif fonksiyonları değerlendirildi. Bu parametre için olguların yaşına en yakın kardeşi kontrol grubu olarak alındı. Yaşam kalitesini etkileyen yakınmalar anket ile sorgulandı. İstatiksel veriler SPSS 15.0 programı ile değerlendirildi. Ki-kare test, Mann-Whitney U test ve Pearson korelasyon testleri uygulandı. İstatiksel anlamlılığı yansıtan değer olarak p
Özet (Çeviri)
Objectives: Leukemia is the most common malignancy affecting children. The cure rate has improved with advances in the treatment of acute leukemia, and this increased survival. There is a large number of children surviving leukemia, therefore monitoring the late effects become more important. Many studies have demonstrated late effects. Growth failure, obesity, cardiac toxicity, endocrinological and gastrointestinal diseases, pulmonary complications, pubertal disorders, infertility, osteopenia, osteoporosis, neurocognitive dysfunctions, neurological, visual and auditory disorders and second neoplasms are the most reported late effects. The neurocognitive dysfunctions that are caused by acute leukemia treatment may affect health and life quality of the survivors of childhood leukemia. The objective o this study is to identify the neurophyschiatric late effects of treatment and provide an assesment about the degree and incidence of these late effects and give therapy if needed.Patients and Methods: This study was performed with patients treated between 1993-2009, in Dokuz Eylül University Hospital Department of Pediatric Hematology who had been diagnosed as acute leukemia at least five years ago. All of the patients were treated with BFM protocols and none of them relapsed. Demographic features, signs of neurologic and eye examination were evaluated. Cranial MR imaging, hearing tests and neurocognitive tests were performed and the results are noted. The control group for neurocognitive tests were consisted of brother or sister of the patient who has the closest age to the patient. Quality of life questionnarie were filled by patients or parents. In the statistical analysis of data, SPSS (The Statistical Package for Social Sciences) 15.0 packet program was used. Chi Square test, Mann Whitney U test and Pearson correlation test was used as statistical method. The p values less than 0.05 was considered significant.Results: In our study there were 44 patients whom were 8-31 years old (mean age 16.4±6.4 years). Of 44 acute leukemia survivors, 21 (%47.7) were females and 23 (%52.3) were males. Five (%11.4) og the patients was diagnosed as AML and 39 (%88.6)of them was diagnosed as ALL. Patients that had been off therapy for 2-18 years (mean 7.5±4.4 years), were diagnosed at least 5 years ago. One or more late effects detected by examination, neurologic tests and neurocognitive tests occured in 32 (%80) patients, and 28 (%63.6) patients specified at least one complaint in the quality of life questionnaire. Abnormalities was found in four (%9.1) patients by eye examination and four (%9.1) by hearing tests. MR imagings revealed pathological findings in eight (%18.2) patients and there were abnormality of EEG in four (%9.1) patients. When total intelligence scores of 44 patients were evaluated, it was seen that 13(%29.5) patients? IQ scores were less than 80 and 28 (%70) patients? scores demonstrated neurocognitive dysfunctions. When the patients and control group were compared, there was no statistical significant difference in neurocognitive test results. Acoording to the questionnaire?s data the most frequent complaint was headache in 19 (%43) patients. The most common problem in school was denoted by 5 (%11.4) patients as diffuculties in concentration.Conclusion: In our study at least one neuropyschiatric late effect occured in most of the cases. It was statistically significant that the patients who had central nervous system involment at the time of diagnosis had more finding on neurologic examination and tests. Based on the BFM protocol risk criterias the patients in the high risk group at the time of the diagnosis had higher incidence of cataract. Tha patients who are older than 18 during the study, or younger than 6 at the time of diagnosis, or had AML, or had taken high dose (18 Gy) RT were have lower IQ scores. Also neurocognitive disorders more detected in the patients who were older than 18 at the time of study. This situation has been thought that neuropyschicological disorders occur more in older ages. Therapeutic exposures including radiotherapy or chemotherapy will place some acute leukemia survivors at a risk of development of neurological and neurocognitive late effects, because of this long term follow up of childhood acute leukemia survivors is essential.
Benzer Tezler
- Erişkin akut lenfoblastik lösemili hastalarda immünofenotipik özelliklerin prognoz üzerine olan etkilerinin değerlendirilmesi
Başlık çevirisi yok
MUSTAFA N. YENEREL
Tıpta Uzmanlık
Türkçe
2000
Hematolojiİstanbul Üniversitesiİç Hastalıkları Ana Bilim Dalı
PROF. DR. TANJU ATAMER
- Çocukluk çağı akut lenfoblastik lösemilerinde tedavinin kemik mineral metabolizmasına etkileri
Effects of childhood acute lymphoblastic leukemia treatment over bone mineral metabolism
SÜMEYRA GEDİK ÇALIŞKAN
Tıpta Uzmanlık
Türkçe
2018
Çocuk Sağlığı ve Hastalıklarıİstanbul ÜniversitesiÇocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
PROF. DR. SERAP KARAMAN
- Evre I germ hücreli testis tümörlerinde adjuvan tedavi ve aktif izlem olgularının klinik ve laboratuvar sonuçlarının karşılaştırılması
Comparison of the clinical and laboratory outcomes of patients with stage I germ cell tumors undergoing adjuvant treatment and active surveillance
AHAD SAFARALIYEV
Tıpta Uzmanlık
Türkçe
2023
ÜrolojiOndokuz Mayıs ÜniversitesiÜroloji Ana Bilim Dalı
PROF. DR. YARKIN KAMİL YAKUPOĞLU
- Determining biological factors associated with chemotherapy response in glioblastoma patients
Glioblastoma hastalarında kemoterapiye yanıt ile ilişkili biyolojik faktörlerin belirlenmesi
HATİCE SEVİM NALKIRAN
Doktora
İngilizce
2012
Tıbbi BiyolojiUniversity of New South WalesTıbbi Biyoloji Ana Bilim Dalı
DOÇ. DR. KERRIE LEANNE MCDONALD