Cognitive Functioning After Hematopoietic Cell Transplantation for Hematologic Malignancy: Results From a Prospective...

Area of Science:

• Neuroscience
• Hematology
• Oncology

Background:

• Cognitive impairment is a known complication following myeloablative allogeneic hematopoietic cell transplantation (HCT).
• The long-term cognitive effects of reduced-intensity allogeneic HCT and autologous HCT are less understood.
• Assessing cognitive function across different HCT types is crucial for patient care and outcome prediction.

Purpose of the Study:

• To compare cognitive functioning in patients undergoing myeloablative allogeneic, reduced-intensity allogeneic, and autologous HCT with healthy controls.
• To identify trends and risk factors associated with cognitive impairment after various HCT modalities.
• To evaluate the long-term impact of HCT on different cognitive domains.

Main Methods:

• A cohort of 477 HCT recipients (autologous, reduced-intensity allogeneic, myeloablative allogeneic) and 99 healthy controls underwent neuropsychological testing.
• Testing was conducted pre-HCT and at 6 months, 1, 2, and 3 years post-HCT.
• Statistical analysis using piecewise generalized estimating equation models compared cognitive scores and identified associated variables.

Main Results:

• Myeloablative allogeneic HCT recipients showed significant post-HCT cognitive decline in executive function, processing speed, and fine motor dexterity compared to controls.
• Autologous and reduced-intensity allogeneic HCT recipients had comparable cognitive scores to controls initially, but reduced-intensity recipients showed delayed decline in executive function and memory by 3 years.
• Older age, male sex, and lower socioeconomic/educational factors were associated with increased post-HCT cognitive impairment.

Conclusions:

• Myeloablative allogeneic HCT is associated with significant cognitive impairment, while autologous HCT generally spares cognitive function.
• Reduced-intensity allogeneic HCT recipients may experience delayed cognitive decline, suggesting a need for long-term monitoring.
• Identifying at-risk populations is essential for developing targeted interventions to mitigate cognitive deficits post-HCT.