Cognitive impairment in hematology patients planned for chimeric antigen receptor T-cell therapy

Chimeric antigen receptor T-cell (CAR-T) therapy is used to treat several types of relapsed and refractory hematological malignancies and is associated with cognitive side-effects. The accurate diagnosis of cognitive impairment following CAR-T requires knowledge of baseline cognitive status prior to the therapy.

Adult patients with advanced hematologic or solid organ malignancies underwent cognitive assessment, including a self-report questionnaire of psychopathology and subjective cognitive function, prior to receiving CAR-T. A subset of individuals also completed the Montreal Cognitive Assessment (MoCA) to examine utility of cognitive screening.

Of 60 patients included, 16 (27%) had cognitive impairment, with six unique patterns of dysfunction. Memory impairment was the most common finding (15%). Impaired patients were more likely to have B-cell acute lymphoblastic leukemia (p = 0.024, BF₁₀ = 9.30), be younger (p = 0.007, BF₁₀ = 7.76), have bone marrow involvement (p = 0.037, BF₁₀ = 5.18), or have evidence of psychopathology (p = 0.004, BF₁₀ = 31.30). Analyses did not support the utility of cognitive screening. Of those patients who completed a self-report measure of psychopathology, nine (16%) were elevated on at least one symptom domain.

The findings demonstrate a broad spectrum of cognitive and psychological symptoms, emphasizing the importance of baseline evaluation for detecting cognitive symptoms that might arise after CAR-T.