Cognitive function in the acute course of allogeneic hematopoietic stem cell transplantation for hematological malignancies

Abstract

The aim of the study was to assess cognitive performance in patients with hematological malignancies before, and 3 months after, allogeneic hematopoietic stem cell transplant (HSCT). A consecutive sample of 39 patients was assessed before admission with a comprehensive neuropsychological test battery and health-related quality-oflife (HRQoL) questionnaires; 19 of these patients were retested around 100 days post HSCT. Test results were compared with normative data and revealed minimal differences at both time points in the level of group-means. One parameter -simple reaction time -was significantly worse (prolonged) at second measurement after HSCT. According to the definition of an impairment score (more than three impaired functions), 26% of patients were classified as impaired before as well as after HSCT. Neuropsychological test results did not vary systematically according to medical variables such as extent of pretreatment, graft-versus-host-disease (GvHD) and kind of conditioning protocol. As a dimension of HRQoL, selfrated cognitive function was in the normal range before and after HSCT. Significant correlations between HRQoL and neuropsychological parameters were related to symptom scales. This study showed impairments of neuropsychological performance for a subgroup of patients before and after allogeneic HSCT. Systematic effects of conditioning, medical variables or self-rated HRQoL could not be observed.

The symptom experience in the first 100 days following allogeneic hematopoietic stem cell transplantation (HSCT)

“…It is plausible that had more comprehensive symptom measures been selected and applied in this population [60,[72][73][74] additional symptoms, than those reported in this study, may have emerged as prevalent. As a secondary analysis, this study was constrained by the use of an instrument that evaluates only two aspects of the symptom experience: symptom occurrence and symptom distress.…”

Quality of life after allogeneic hematopoietic cell transplantation

“…Emotional functioning for survivors is most compromised before transplantation and immediately after, 23,24 with significant improvements seen as early as hospital discharge 23 to 100 days. 24,29,30 Some data suggest that emotional functioning remains relatively stable after this initial improvement, 23,29 although other data suggest that it continues to improve in the 2 24 to 4 26 years after transplantation. In general, survivors can expect average improvements in emotional functioning of .3 to .4 SD from before to after transplantation.…”

“…2,23,24,27,29,30 Physical functioning then begins to improve, with 2 studies 2,24 finding that physical functioning plateaus in the year after transplantation and another study 26 finding continued improvement over 4 years. Regarding the magnitude of improvement, 3 studies reported that mean levels of posttransplantation physical functioning were higher by .1 to .2 SD compared with pretransplantation levels, 2,23,24 2 reported that they were lower by .8 to 1.3 SD, 29,30 and 2 did not report SD.…”

Successful treatment of stress-induced cognitive impairment with haloperidol; evaluation also warranted in hematopoietic stem cell transplantation

“…Although chemotherapy induced damage of the white and grey matter of the brain has been reported to be causative, several publications connote that emotion and anxiety associated with the disease and it's treatment play a role [6,7,15].…”

“…Schultz-Kindermann et al, examined cognitive functioning before (n=39) and 3 months after (n=19) allogeneic transplantation for hematological malignancies [7]. They found that 26% of patients was impaired before as well as after transplant, but simple reaction time was significantly worse.…”