Neurocognitive Impairment After Hematopoietic Stem Cell Transplant for Hematologic Malignancies: Phenotype and Mechanisms

Abstract

Hematopoietic stem cell transplant (HSCT) plays a central role in the treatment of hematologic cancers. With the increasing survival of patients after HSCT, survivorship issues experienced by this population have become an important outcome. Cognitive impairment is an established sequela of HSCT, with studies to date establishing its presence, associated risk factors, and clinical phenotype. There are multiple potential contributors to cognitive impairment post-HSCT. Efforts are ongoing to further characterize its clinical phenotype, associated biomarkers, and biologic underpinnings. A fundamental knowledge of post-HSCT cognitive impairment is of value for all clinicians that interface with this population, and further academic efforts are needed to more fully understand the impact of this cancer treatment on brain health. The Oncologist 2021;9999:• • Implications for Practice: As survival outcomes after hematopoietic stem cell transplantation (HSCT) improve, an awareness of the post-treatment challenges faced by this population has become central to their care. HSCT can have a sustained and broad impact on brain health, causing cognitive dysfunction, fatigue, disturbed mood, and sleep. In affected patients, autonomy, return to work, relationships, and quality of life may all be affected. A fundamental fluency in this area is important for clinicians interfacing with HSCT survivors, facilitating the identification and management cognitive dysfunction and concurrent symptom clusters, and stimulating interest in these sequelae as areas for future clinical research.

Qualidade de Vida de Sobreviventes de Câncer Onco-hematológicos Submetidos ao Transplante de Células-Tronco Hematopoiéticas: Revisão Integrativa da Literatura

“…Adicionalmente, outros efeitos adversos como infecções recorrentes, disfunções no funcionamento sexual e fértil, neoplasias secundárias e sintomas físicos como dor, distúrbios do sono e alterações cognitivas demonstraram influenciar negativamente no bem-estar, além de poderem estar relacionadas a reinternações hospitalares, procura constante por atendimento médico e aumento do estresse, ansiedade e medo, postergando o retorno à rotina diária 31,34 .…”

Remote assessment of cognitive dysfunction in hematologic malignancies using web‐based neuropsychological testing

“…We conducted an exploratory linear regression analysis within the cancer group to examine the effects of demographic, clinical, and psychosocial variables on cognitive function. Specifically, we included racial/ethnic minority status (minority = 1, non‐minority = 0), age (years), education (years), and sex (male = 1, female = 0) as these are known to contribute to cognitive performance in patients with cancer and other neurologic conditions, 25 , 26 corticosteroid treatment (1 = yes, 0 = no), immunotherapy (1 = yes, 0 = no), and post‐transplant days given prior studies demonstrating that these can affect cognitive function, 1 , 3 , 27 and physical functioning score, fatigue score, and income level (1 = greater than $100 K, 0 = lower than $100 K) as these differed between groups. Cancer diagnosis (lymphoma = 1, myeloma = 0) was also included given that these have different pathologies and treatment regimens which may result in different cognitive outcomes.…”

“…Certain hematologic cancers, including multiple myeloma (MM) and non-Hodgkin's lymphoma (NHL) undergo more intensive treatment regimens that may be associated with higher risk for cognitive decline. 1 These treatments can include high dose chemotherapy, immunotherapy, high dose steroid, and hematopoietic stem cell transplant (HSCT) that may affect memory, attention, and executive function [2][3][4] months and years after treatment completion, 5 with worse cognitive outcomes when these treatment modalities are combined. 1,6 Cognitive functioning encompasses multiple abilities that are essential for treatment compliance.…”

“…However, most studies to date have involved patients with breast cancer and therefore less is known regarding cognitive effects in other malignancies. Certain hematologic cancers, including multiple myeloma (MM) and non‐Hodgkin's lymphoma (NHL) undergo more intensive treatment regimens that may be associated with higher risk for cognitive decline 1 . These treatments can include high dose chemotherapy, immunotherapy, high dose steroid, and hematopoietic stem cell transplant (HSCT) that may affect memory, attention, and executive function 2–4 months and years after treatment completion, 5 with worse cognitive outcomes when these treatment modalities are combined 1,6 …”

“… 1 These treatments can include high dose chemotherapy, immunotherapy, high dose steroid, and hematopoietic stem cell transplant (HSCT) that may affect memory, attention, and executive function 2 , 3 , 4 months and years after treatment completion, 5 with worse cognitive outcomes when these treatment modalities are combined. 1 , 6 …”