Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant

Abstract

Research indicates that myeloablative hematopoietic cell transplantation (HCT) impairs neurocognitive function. However, prospective studies on long-term effects are lacking. This longitudinal study examined neurocognitive changes over the first year in 142 adult recipients of allogeneic HC transplants who received neuropsychologic testing before transplantation and again after 80 days and 1 year. Age-, sex-, and education-adjusted population-based standardized scores were used for normative comparisons. Performance on all tests declined from before transplantation to 80 days (P < .05) and improved by 1 year (P < .05), returning to pretransplantation levels on all tests except for grip strength and motor dexterity. Although verbal fluency and memory recovered by 1 year, both were below norms at all 3 testing times (P < .01). Logistic regressions indicated that patients without chemotherapy, other than hydroxyurea, previous to HCT and patients not receiving chronic graft-versus-host disease (GVHD) medication at 1 year had lower risk of impaired function (P < .05). In conclusion, HCT was associated with significant generalized decline in neurocognitive performance at 80 days, with subsequent recovery to pretransplantation levels by 1 year for most survivors, except on motor tasks. Results indicate that long-term cognitive decrements, as distinct from motor disabilities, infrequently derive directly from HCT. (Blood.

Pre-transplantation physical and mental functioning is strongly associated with self-reported recovery from stem cell transplantation

“…Our results look at recovery during the first year after transplantation, whereas previous work has shown that full recovery may take 3-5 years. 20,34 Further follow-up is needed to determine if pre-transplantation QOL is predictive of QOL several years post transplantation. In addition, precise assessment of disease risk is limited by the heterogeneity of the diagnoses in our cohort.…”

Rehabilitation of therapy-related cognitive deficits in patients after hematopoietic stem cell transplantation

“…Cognitive impairment correlated with neuroradiological peculiarities, in particular diffuse damage in the white matter that in turn is associated with deficits in attention and information-processing speed. 37 Syrjala et al 38 investigated 142 patients at three time points (pre-HSCT, and 80 days and 1 year post-HSCT). They observed significant reductions in neuropsychological performance throughout between the first and second time points.…”

Process of allogeneic hematopoietic cell transplantation decision making for older adults

“…Studies on cognitive changes generally include a large age range and samples of either autologous and alloHCT patients, 18,20,22 or only patients receiving myeloablative alloHCT. 21,23,24 To our knowledge, the impact of non-myeloablative alloHCT on cognitive functioning in older adults is not known.…”

“…29 Arora et al 30 found that patients with low income were over three times as likely to report frailty after transplant. 23 Therefore, financial stress negatively impacts patients' long-term health and ongoing treatment decisions.…”