Are Recipients of Hematopoietic Cell Transplantation at Risk for Cognitive Decline?
Posted: Tuesday, April 10, 2018
Based on the results of a prospective longitudinal study, published in the Journal of Clinical Oncology, recipients of myeloablative allogeneic hematopoietic cell transplantation (HCT) experienced significant cognitive decline compared with healthy controls. However, most recipients of autologous HCT generally did not demonstrate cognitive impairment in the years after transplantation.
In this study, nearly 500 recipients of HCT underwent standardized neuropsychological testing before and at 6 months, 1 year, 2 years, and 3 years after transplantation. A total of 236 had an autologous transplant, 128 had a reduced-intensity allogeneic transplant, and 113 had a myeloablative allogeneic transplant. About 20% of all transplant recipients had multiple myeloma. In addition, about 100 frequency-matched healthy controls underwent testing.
Three years after transplantation, 35.7% of allogeneic transplant recipients as well as 18.7% of autologous transplant recipients showed evidence of global cognitive impairment. Significantly lower post-HCT scores for executive function, verbal speed, processing speed, auditory memory, and fine-motor dexterity were reported in myeloablative HCT recipients than in controls. In those who received reduced-intensity HCT, pre-HCT to 3 years post-HCT scores for executive function, verbal fluency, and working memory declined significantly.
“Allogeneic HCT recipients with global cognitive deficits were at a 10-fold increased risk of not returning to work, which suggests that cognitive impairment is a significant barrier to societal reintegration for this vulnerable population,” revealed Noha Sharafeldin, MD, PhD, of the University of Alabama at Birmingham, and colleagues.