Pretransplantation Cognitive Dysfunction in Advanced-Age Hematologic Cancers: Predictors and Associated Outcomes

Area of Science:

• Hematology
• Neuroscience
• Oncology

Background:

• Patients with hematologic cancers undergoing allogeneic hematopoietic stem cell transplantation (HSCT) face risks of cognitive dysfunction due to factors like age and prior treatments.
• Cognitive impairment can negatively influence treatment decisions, adherence to post-transplant care, and overall survival.

Purpose of the Study:

• To assess the prevalence of cognitive dysfunction in patients before and after allogeneic HSCT.
• To identify predictors of cognitive dysfunction in this patient population.
• To examine the longitudinal changes in cognitive function following HSCT.

Main Methods:

• A cohort of 448 patients admitted for HSCT between 2011 and 2014 were assessed using the Montreal Cognitive Assessment (MoCA) pre-transplant.
• 260 patients were reassessed post-transplant before discharge.
• Predictor variables included age, Karnofsky Performance Status, sex, disease type, and psychotropic medication use.

Main Results:

• Pre-transplant, 36.4% of patients exhibited cognitive dysfunction.
• Older age and specific disease types (myelodysplastic syndrome [MDS], myeloproliferative disorder [MPD]) were significant predictors.
• Cognitive dysfunction did not show a significant association with overall survival (OS) or nonrelapse mortality (NRM).
• A significant cognitive decline was observed from pre- to post-transplant, with one-third of patients showing dysfunction at discharge.

Conclusions:

• A substantial proportion of HSCT candidates have cognitive dysfunction, with older patients and those with MDS/MPD being at higher risk.
• Cognitive dysfunction may worsen after HSCT, highlighting the need for pre-transplant assessment and post-discharge support.
• Further longitudinal studies are required to understand the impact of HSCT on cognitive function and its effect on outcomes.