Mental status changes after hematopoietic stem cell transplantation

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.

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 = 91) or MDS (n = 15) at enrollment and then 12 months and 18 months after HSCT or other therapy.

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 = .034), worse physical function (P = .049), and more difficulty with coordination and fine motor speed bilaterally (dominant hand, P = .005; nondominant hand, P = .0019). Patients with CML overall had improved phonemic fluency (P = .014).

The current study indicated that time and diagnosis may be important factors when assessing neurocognitive and other changes. Complaints regarding "chemobrain" after HSCT merit further study, because deficits actually may predate the initiation of treatment and subsequently may improve. The study results could reassure prospective HSCT recipients, because HSCT compared favorably with other treatments when mental status side effects were considered.