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Nearly half of stem cell transplant survivors had reduced neurocognitive function after 5 years
Syrjala KL. J Clin Oncol. 2011;doi:10.1200/JCO.2010.33.9119.
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Brain function improved in time after allogeneic hematopoietic cell transplantation, but two of five patients still had reduced function after 5 years.
In a prospective and longitudinal study, participants completed standardized neuropsychological tests for information processing speed, verbal memory, executive function, and motor dexterity and speed. Researchers assessed 92 survivors at four time points: 2 to 14 days before the start of transplantation; 80 days after transplantation; roughly 1 year after transplantation; and at 5 years after transplantation. Sixty-six age- and sex-matched controls underwent the same evaluation at 5 years.
At 5 years, 66 surviving patients completed neurocognitive testing and had a matched control. The 80-day assessment was the worst across all tests.
For the 5-year survivors, 38% had mild impairments (global deficit score of 0.50-1.99), and 3% were moderately impaired (2.00-4.99). No survivor was severely impaired.
Except for motor dexterity and speed, brain function had returned to pre-transplantation levels by 1 year in most patients. Patients demonstrated further improvement from 1 to 5 years for information processing speed and executive function.
“For several measures, the 5-year average score was significantly higher than pre-hematopoietic transplantation,” researchers wrote.
However, patients showed persistent deficits in motor speed and dexterity for both their dominant (P=.017) and nondominant (P=.683) hands. Additionally, patients’ verbal memory scores did not improve beyond pre-hematopoietic transplantation functioning.
This is a well-conducted study which serially examines individuals at baseline, at 80 days, 1 and 5 years after myeloablative allogeneic hematopoietic cell transplantation and shows a decline, then recovery, in almost all aspects of neurocognitive function including executive function. But there are areas of caution. We don't know why motor speed and dexterity were still deficient. These results clearly indicate that we need to follow these allograft recipients throughout their lives. An allogeneic transplant is a lifelong commitment by the patient, the family and the caregiver. Following these patients closely for late events is mandatory. That may be different in patients given autologous transplant, or perhaps those undergoing nonmyeloablative transplantation. Many of us who have been involved in long-term follow-up caution that patients require close and life-long follow-up because their new normal is an allogeneic new normal wherein a new hematopoietic cell donor is resident in the host.
- Keith M. Sullivan
HemOnc Today Editorial
Board member
Disclosure: Dr. Sullivan reported no relevant financial disclosures
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