APA: Bone-Marrow Transplantation May Slow Childhood Development

SAN FRANCISCO, Aug. 24 -- Infants who undergo bone-marrow transplantation may pay a price in a decline in communication and other developmental skills.

The long isolation inherent in the procedure is the culprit, said Linda Ruthruff, Ph.D., a post-doctoral fellow in infant development at San Francisco General Hospital.

"Infants younger than two at the time of bone marrow transplantation are at risk of declines in IQ and for slowing the rate of acquisition of developmental skills," she and colleagues reported at the American Psychological Association meeting here.

However, Dr. Ruthruff said her study of 54 infants who underwent the procedure for cancer or immunological diseases indicated that factors related to lessening of impairment is related to a younger age and a shorter period of isolation.

"Our study specifically examined how bone-marrow transplantation procedures impact the communication and socialization skills of these children," she said at her poster presentation.

"While survival of these children is improving," Dr. Ruthruff said, "we need to know if therapeutic interventions can improve functioning if outcomes are poor. There is very little information in the bone-marrow transplantation literature regarding infant outcome. We know family life is disrupted."

Dr. Ruthruff and researchers at the Pacific Graduate School of Psychology and the University of California at San Francisco said that their exploration of the psychosocial development of these children revealed significant deficits in IQ development, declines in behavior scores, and impaired communication skills.

In her group of patients, 26 had forms of severe combined immunodeficiency, eight had inborn metabolism errors, seven had leukemia, six had other forms of immunodeficiency diseases, two were diagnosed with neuroblastoma, two had non-malignant hematological disorders, and one each had a germ cell tumor, an undefined tumor, and a marrow stem cell deficit. All the children were treated at UCSF from 1986 to 2003.

The researchers tested the children before undergoing the bone marrow transplantation and after an average of 14.5 months post-therapy. The researchers used the validated Vineland Adaptive Behavior Scales and Bayley Scales of Infant Development. Data were analyzed using multiple regression analyses.

On the Vineland scale domains:

• Communication skills declined from a mean of 99.09 to 90.25, a medium to large effect (P<0.001).
• Socialization skills declined from a mean of 100.44 to 94.56, a medium effect (P=0.001).
• Daily living skills declined from a mean of 97.95 to 90.63, a medium effect (P=0.001).
• Motor skills declined from a mean of 92.38 to 89.98, a nonsignificant effect (P=0.175).

On the Bayley scales:

• Mental development index declined from a mean of 94.95 to 88.82, a nonsignificant effect (P=0.062).
• Psychomotor development skills declined from a mean of 82.44 to 78.75, a nonsignificant effect (P=0.381).

"The process of bone marrow transplantation usually involves a long period of compromised immunity and potential neurotoxic procedures," Dr. Ruthruff noted. "The infant is kept in medical isolation at the hospital for periods ranging from a few days to six or more months. When the infant returns home, isolation and social restrictions continue for a period lasting from a few months to a year. Sanitation and prevention of the introduction of germs into the home environment severely curtail the infant's and family's activities."

"Many infants are exposed to high-dose ablative chemotherapies and/or total body radiation to prepare their body for the new bone marrow. Some were previously exposed to multiple courses of chemotherapy. Some are given agents to prevent and/or treat graft-versus-host disease."

The results of this study are not surprising," said Jacqueline Lefkowitz, LCSW, a master social work clinician at New York Presbyterian Hospital-Weill Cornell Medical College. "Events occurring in the earliest stage of life play a crucial role in the cognitive and emotional development of children."

Lefkowitz said that cancer and cancer treatments are often traumatic. "Traumatic experiences strongly influence psychosocial development," she added. "However, all experiences are mediated by the parents or the primary attachment figures."

She recommended further studies into "whether parents' coping styles influence the interactions with their child and whether, in turn, these interactions also play a significant role in the child's growth and development."