Cognitive Function After Hematopoietic Cell Transplantation for Hematologic Malignancy

Key Points

  • Myeloablative allogeneic HCT recipients had significant cognitive declines compared with controls.
  • Delayed decline was observed in reduced-intensity allogeneic HCT recipients.

In a prospective longitudinal study reported in the Journal of Clinical Oncology, Sharafeldin et al found that cognitive function after hematopoietic cell transplantation (HCT) for hematologic malignancy was impaired among those receiving myeloablative allogeneic HCT, with a delayed effect being observed among those receiving reduced-intensity allogeneic HCT.

Study Details

The study included 477 patients (median age = 52 years) receiving HCT for hematologic malignancies at City of Hope between 2005 and 2011. Of these, 236 received autologous, 128 reduced-intensity allogeneic, and 113 myeloablative allogeneic HCT. Patients had standardized neuropsychologic testing before HCT and at 6 months and at 1, 2, and 3 years after HCT. Testing was performed in 99 healthy controls matched for age, sex, and annual household income at similar time points.

Cognitive Function Trends

Post-HCT overall scores were similar for controls and autologous and reduced-intensity HCT recipients. Compared with controls, myeloablative HCT recipients had significantly lower (P ≤ .003) post-HCT overall scores vs controls for executive function, verbal speed, processing speed, auditory memory, and fine motor dexterity.

Compared with pre-HCT scores, scores at 6 months post-HCT did not significantly change after reduced-intensity HCT, but were significantly worse for fine motor dexterity at both 6 months and 3 years (P ≤ .003) after myeloablative HCT. Compared with pre-HCT scores, scores at 3 years post-HCT significantly worsened (P ≤ .003) for executive function, verbal fluency, and working memory among reduced-intensity HCT recipients.  

Overall, older age, male sex, and lower education, income, and cognitive reserve were associated with post-HCT cognitive impairment. At 3 years post-HCT, global cognitive impairment was present in 18.7% of autologous and 35.7% of allogeneic HCT recipients.

The investigators concluded, “Myeloablative allogeneic HCT recipients showed significant cognitive decline compared with healthy controls. Reduced-intensity allogeneic HCT recipients showed evidence of delayed decline. Cognitive functioning in autologous HCT recipients generally was spared. The study identified vulnerable subpopulations that could benefit from targeted interventions.”

The study was supported in part by the Leukemia and Lymphoma Society.

Smita Bhatia, MD, MPH, of the Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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