Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Blood (Impact Factor: 9.78). 11/2004; 104(10):3386-92. DOI: 10.1182/blood-2004-03-1155
Source: PubMed

ABSTRACT Research indicates that myeloablative hematopoietic cell transplantation (HCT) impairs neurocognitive function. However, prospective studies on long-term effects are lacking. This longitudinal study examined neurocognitive changes over the first year in 142 adult recipients of allogeneic HC transplants who received neuropsychologic testing before transplantation and again after 80 days and 1 year. Age-, sex-, and education-adjusted population-based standardized scores were used for normative comparisons. Performance on all tests declined from before transplantation to 80 days (P < .05) and improved by 1 year (P < .05), returning to pretransplantation levels on all tests except for grip strength and motor dexterity. Although verbal fluency and memory recovered by 1 year, both were below norms at all 3 testing times (P < .01). Logistic regressions indicated that patients without chemotherapy, other than hydroxyurea, previous to HCT and patients not receiving chronic graft-versus-host disease (GVHD) medication at 1 year had lower risk of impaired function (P < .05). In conclusion, HCT was associated with significant generalized decline in neurocognitive performance at 80 days, with subsequent recovery to pretransplantation levels by 1 year for most survivors, except on motor tasks. Results indicate that long-term cognitive decrements, as distinct from motor disabilities, infrequently derive directly from HCT.

Download full-text


Available from: Sari Roth-Roemer, Mar 18, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective Bone Marrow Transplantation is considered one of the main procedures used in the treatment of both malignant and non-malignant diseases. Psychological factors after Bone Marrow Transplantation have an important role in the survival of the patients undergoing this procedure. Method In the present study, some parameters including depression, anxiety and cognition were assessed during both pre and post-transplantation in patients undergoing Bone Marrow Transplantation. The evaluations were performed by utilizing several questionnaires including Hospital Anxiety and Depression Scale and Wechsler Memory Scale within 72 hours after hospitalization (pre-transplantation) and one month after transplantation (post-transplantation). All patients received intensive chemotherapy during the first 72 hours after hospitalization. Paired t test was used to compare pre and post values. SPSS (version 18) was used to analysis the data. The significance level was defined as p < 0.05. Results Twenty one patients who were not receiving any antianxiety agents at least for two weeks prior to and during this study were included. It was noted that anxiety was significantly less at post-transplantation compared to its pre-transplantation level (P = 0.008). However, no significant difference was found between pre and post-transplantation depression. Memory function was significantly improved at post-transplantation compared to pre-transplantation (P = 0.001). Conclusion The authors suggest that the improvement of anxiety and memory status of the patients one month after the bone marrow transplantation is expected even in the absence of consumption of any antianxiety agents. However, antidepressants may be needed to help those patients who undergo bone marrow transplantation.
    03/2014; 9(2):64-68.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Longitudinal data of neurocognitive functions and quality of life (QOL) were obtained for a cohort of 25 patients followed before transplant and through the first year after haematopoietic stem cell transplantation (SCT). A battery of neuropsychological tests and two self-report questionnaires were used to assess neurocognitive functions, QOL and psychological functioning. In comparison to normative data, up to one-fourth of the patients experienced impaired functioning on several cognitive domains before SCT. Random regression modelling revealed a slight improvement in the mean group scores of memory tasks over time, especially for younger patients. Impairment in neurocognitive functions was positively related to depression and anger at baseline, and to the emotional functioning scale at follow-up. These preliminary results emphasize the significance of a pre-treatment assessment and the need of a large baseline sample in future longitudinal studies to overcome the expected dropout rate of more than 50%.
    Journal of Clinical and Experimental Neuropsychology 05/2006; 28(3):283-93. DOI:10.1080/13803390490918147 · 2.16 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to examine cognitive performance in patients prior to bone marrow or haematopoietic stem cell transplantation (SCT) and in haematological patients who received non-myeloablative cancer therapies. A consecutive sample of 101 SCT patients and 82 haematological patients completed a neuropsychological test battery and five questionnaires assessing subjective cognitive complaints, psychological functioning, health-related quality of life and fatigue. Results were compared with normative data. Percentages of cognitively impaired patients were equally divided between groups. Most deficits were observed in visual memory, visuospatial and constructional ability and psychomotor functions. The SCT group showed a higher rate of anxiety cases and reported lower cognitive, emotional and social functioning. Results of neuropsychological testing were not associated with outcome of the questionnaires. This study showed impaired cognitive performance prior to SCT. Haematological patients treated with non-myeloablative cancer therapies proved to be a reliable reference group for longitudinal studies.
    European Journal of Cancer 06/2005; 41(7):1007-16. DOI:10.1016/j.ejca.2005.01.015 · 4.82 Impact Factor