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“Despite receiving no neurotoxic therapy directed to the central nervous system, long-term survivors of childhood Hodgkin lymphoma (HL) experience impairment of attention, memory, and executive functioning domains” stated Annalynn M. Williams, PhD, coauthor of a study presented during the American Society of Hematology 62nd Annual Meeting and Exposition.

Researchers at St. Jude Children’s Research Hospital compared data from 1564 HL survivors with 725 of their siblings. Participants responded to a questionnaire that assessed neurocognitive impairment and health conditions. The 4 domains of neurocognitive impairment included task efficiency (processing speed, attention, and persistence), emotional regulation (expression and control of emotions), organization (of plans and immediate environment), and memory (immediate, short-, and long-term).


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Survivors of HL were 52.0% women aged mean 37.5 (standard deviation [SD], 6.0) years and were diagnosed an average 23.6 (SD, 4.7) years ago. The siblings were 54.5% women aged 33.2 (SD, 8.5) years.

Neurologic impairment was elevated among HL survivors, compared with their siblings, for task efficiency (10.8% vs 7.7%), emotional regulation (16.6% vs 11.5%), organization (12.1% vs 10.3%), and memory (8.1% vs 5.7%).

Stratified by demographic characteristics, higher impairment risks were observed among women survivors for emotional regulation (risk ratio [RR], 1.44; 95% CI, 1.08-1.92; P <.05) and memory (RR, 2.00; 95% CI, 1.33-3.00; P <.05), and among non-White survivors for task efficiency (RR, 2.08; 95% CI, 1.24-3.50; P <.05) and emotional regulation (RR, 1.65; 95% CI, 1.02-2.66; P <.05).

Survivors who had a late relapse had increased risk for task efficiency impairment (RR, 1.57; 95% CI, 1.06-2.33; P <.05).

Smoking status was associated with higher risk for impairments of task efficiency (former: RR, 1.53; P <.05; current: RR, 1.93; P <.05), emotional regulation (former: RR, 1.42; P <.05; current: RR, 2.49; P <.05), and memory (former: RR, 1.87; P <.05; current: RR, 1.73; P <.05).

Survivors who had cardiovascular conditions (32.9%) were at increased risk for all 4 impairment domains, patients with neurologic (6.6%) or endocrine (54.3%) conditions were at increased risk for task efficiency, emotional regulation, and memory impairments, and patients with pulmonary morbidity (8.5%) were at increased risk for task efficiency impairments.

There was little evidence that HL treatment exposures (bleomycin, corticosteroids, or chest radiation) were associated with impairment.

This study may have been limited by the self-reporting design and the inability to assess dose-risk relationships.

“Long-term survivors of childhood Hodgkin lymphoma are at an increased risk for neurocognitive impairment. While we did not see treatment effects, we did see potentially modifiable risk factors such as smoking, physical activity, and chronic health conditions. Future research should focus on interventions to mitigate or prevent neurocognitive impairment in this population” concluded Dr Williams.

Reference

Williams AM, Xing M, Salehabadi SM, et al. Prevalence and predictors of neurocognitive impairment in long-term survivors of childhood Hodgkin lymphoma: a report from the Childhood Cancer Survivor Study. Presented at: American Society of Hematology (ASH) 62nd Annual Meeting and Exposition; December 5-8, 2020. Abstr 370.