Mental status changes after hematopoietic stem cell transplantation

Abstract

BACKGROUND:The growing numbers of survivors of innovative cancer treatments, such as hematopoietic stem cell transplantation (HSCT), often report subsequent cognitive difficulties. The objective of this study was to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia (CML) or primary myelodysplastic syndrome (MDS) after allogeneic HSCT or other therapies. METHODS: In this prospective cohort study, serial evaluations of attention, concentration, memory, mood, and quality of life were used in a consecutive sample of 106 eligible patients who had CML (n ¼ 91) or MDS (n ¼ 15) at enrollment and then 12 months and 18 months after HSCT or other therapy. RESULTS: The 3 evaluations at enrollment, 12 months, and 18 months were completed by 98%, 95%, and 89% of surviving participants, respectively. Among all patients, there was significant improvement in memory over 18 months. For example, the 45 patients who underwent HSCT (42 patients with CML and 3 patients with MDS) compared favorably with the patients who received other treatment on most measures of neuropsychological function, except they had improved mental health (P ¼ .034), worse physical function (P ¼ .049), and more difficulty with coordination and fine motor speed bilaterally (dominant hand, P ¼ .005; nondominant hand, P ¼ .0019). Patients with CML overall had improved phonemic fluency (P ¼ .014). CONCLUSIONS: The cur-

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

“…Most adult survivors recover cognitive function within one year but mild impairments remain evident 5 years post-transplant for some survivors (59, 75, 76). Patient-reported problems are typically discrepant with and higher than detected with objective neuropsychological test results.…”

A prospective evaluation of changes in brain structure and cognitive functions in adult stem cell transplant recipients

“…Studies addressing neuropsychological functioning in patients undergoing HSCT reported that 20–40% had cognitive dysfunction involving graphomotor speed, executive and memory abilities prior to transplant (Andrykowski et al, 1992; Chang et al, 2009; Friedman et al, 2009; Harder et al, 2005, 2006; Jacobs et al, 2007; Meyers et al, 1994; Schulz-Kindermann et al, 2007). Several prospective studies documented cognitive decline in the initial months after HSCT (Ahles et al, 1996; Booth-Jones et al, 2005; Friedman et al, 2009; Syrjala et al, 2004; Schulz-Kindermann et al, 2007), but the absence of a decline was also described (Harder et al, 2007).…”

“…Several prospective studies documented cognitive decline in the initial months after HSCT (Ahles et al, 1996; Booth-Jones et al, 2005; Friedman et al, 2009; Syrjala et al, 2004; Schulz-Kindermann et al, 2007), but the absence of a decline was also described (Harder et al, 2007). At approximately one year post-transplant, cognitive functions were reported to return to or surpass pre-transplant levels in several studies (Chang et al, 2009; Harder et at., 2006; Jacobs et al, 2007; Syrjala et al, 2004; Wenz et al, 2000), but subgroups of patients had persistent impairment or decline on some cognitive domains (Jacobs et al, 2007; Meyers et al, 1994; Syrjala et al, 2004). Syrjala and colleagues (2011) reported further improvement in information processing speed and executive functions, but not in memory or motor dexterity in a large cohort of patients evaluated five years following allogeneic HSCT.…”

Prospective Neurocognitive Function Over 5 Years After Allogeneic Hematopoietic Cell Transplantation for Cancer Survivors Compared With Matched Controls at 5 Years

“…[7][8][9][10][11] Research that has assessed patients 6 months or longer post-HCT indicates some recovery of cognitive function after acute deficits. [7][8][9][11][12][13][14][15] However, to our knowledge, no prospective studies have followed HCT patients beyond 2 years after transplantation.…”