TY - JOUR
T1 - Impact of Propofol Exposure on Neurocognitive Outcomes in Children with High-Risk B ALL
T2 - A Children's Oncology Group Study
AU - Alexander, Sarah
AU - Kairalla, John A.
AU - Gupta, Sumit
AU - Hibbitts, Emily
AU - Weisman, Hannah
AU - Anghelescu, Doralina
AU - Winick, Naomi J.
AU - Krull, Kevin R.
AU - Salzer, Wanda L.
AU - Burke, Michael J.
AU - Gore, Lia
AU - Devidas, Meenakshi
AU - Embry, Leanne
AU - Raetz, Elizabeth A.
AU - Hunger, Stephen P.
AU - Loh, Mignon L.
AU - Hardy, Kristina K.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - PURPOSEMany 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.METHODSThis 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.RESULTSOne 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 normative sample. In covariate-adjusted multivariable analysis, cumulative exposure to propofol was associated with a 0.05 Z-score decrease in reaction time/processing speed per each 10 mg/kg propofol exposure (P =.03).CONCLUSIONIn a multicenter and uniformly treated cohort of children with B-ALL, cumulative exposure to propofol was an independent risk factor for impairment in reaction time/processing speed 1 year after therapy. Anesthesia exposure is a modifiable risk, and opportunities to minimize propofol use should be considered.
AB - PURPOSEMany 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.METHODSThis 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.RESULTSOne 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 normative sample. In covariate-adjusted multivariable analysis, cumulative exposure to propofol was associated with a 0.05 Z-score decrease in reaction time/processing speed per each 10 mg/kg propofol exposure (P =.03).CONCLUSIONIn a multicenter and uniformly treated cohort of children with B-ALL, cumulative exposure to propofol was an independent risk factor for impairment in reaction time/processing speed 1 year after therapy. Anesthesia exposure is a modifiable risk, and opportunities to minimize propofol use should be considered.
UR - http://www.scopus.com/inward/record.url?scp=85199705414&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85199705414&partnerID=8YFLogxK
U2 - 10.1200/JCO.23.01989
DO - 10.1200/JCO.23.01989
M3 - Article
C2 - 38603641
AN - SCOPUS:85199705414
SN - 0732-183X
VL - 42
SP - 2671
EP - 2679
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 22
ER -