Neurocognitive outcomes in adult survivors of childhood Hodgkin lymphoma.

Abstract

1532 Background: Adult survivors of childhood Hodgkin lymphoma (HL) are at increased risk for cardiac morbidity as a consequence of previous treatment. Cardiovascular morbidity in non-cancer populations is associated with increased rates of neurocognitive deficits. Methods: Forty-eight adult survivors of childhood HL were randomly selected from a large cohort of childhood cancer survivors (≥ 18 yrs of age and >10 yrs post-diagnosis) recruited for participation in the St. Jude Lifetime Cohort Study. Treatment included high-dose chest radiation (≥ 30 Gy) in Cohort 1 (n = 24) and anthracycline chemotherapy and chest radiation (any dose) in Cohort 2 (n = 24). All survivors completed standardized neurocognitive, cardiac, and brain magnetic resonance imaging examinations. The data were evaluated with one-sample t-tests, independent samples t-tests, and point- biserial correlations. Results: Cohorts 1 and 2 were similar in mean age and time since diagnosis (Cohort 1: age = 43.5 yrs., range 37.4- 52.4, time since diagnosis = 29.1 yrs., range 21.8-27.3; Cohort 2: age = 40.1 yrs., range 37-46.7, time since diagnosis = 23.8 yrs., range 18.4-33.8). Compared to age-adjusted national normative values, significant differences in performance were seen on measures of verbal IQ (p < 0.01), cognitive processing speed (p < 0.01), verbal memory (p < 0.05), sustained attention (p < 0.01), and fine motor speed (p < 0.01). Between groups comparisons revealed significantly lower performance in Cohort 1 on measures of focused attention, sustained attention, cognitive processing speed, and fine motor speed, and lower performance in Cohort 2 on measures of short and long-term verbal memory (all comparisons p < 0.05). Approximately 54% of the sample demonstrated evidence of cardiac complications. Neuroimaging abnormalities (e.g., cerebral volume loss and white matter leukoencephalopathy) were significantly associated with measures of processing speed (p < 0.01) and fine motor speed (p < 0.01). Conclusions: HL survivors demonstrate increased rates of brain impairment, reflected through neurocognitive assessment and neuroimaging studies. Given the sample size, these findings should be interpreted with caution, but do support the need for larger studies in this population. No significant financial relationships to disclose.