Although many people who undergo allogeneic hematopoietic cell transplantation (HCT) recover significant cognitive function posttransplantation, more than 40% of survivors evaluated in one recent study still experienced deficits 5 years later.
Research has demonstrated that patients experience cognitive problems both before and after high-dose treatment followed by HCT, with partial recovery by the 1-year mark. Karen L. Syrjala, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, Washington, led a team that prospectively examined the trajectory and extent of long-term cognitive dysfunction in patients 1 to 5 years after treatment.
The investigators administered standardized neuropsychological tests to measure information-processing speed, verbal memory, executive function, and motor dexterity and speed in 92 survivors of HCT. The subjects were retested 80 days, 1 year, and 5 years posttransplantation. A total of 66 case-matched controls also were tested at the 5-year time point.
Survivors recovered significant cognitive function from 80 days to 5 years posttransplantation in all tests except verbal recall. In the 1-to-5-year time frame, verbal fluency and executive function improved, but motor dexterity remained below that of controls.
Global deficit score (GDS; representative of overall impairment) indicated that 41.5% of survivors and 19.7% of controls had mild or greater deficits. “Although neurocognitive function improved from 1 to 5 years after HCT, deficits remained for more than 40% of survivors,” affirmed the researchers in the Journal of Clinical Oncology. “Risk factors, mechanisms, and rehabilitation strategies need to be identified for these residual deficits.” ONA