Neuropsychological changes from pretransplant to one year in patients receiving myeloablative allogeneic hematopoietic cell transplant.
Karen L Syrjala et al.
Research indicates that myeloablative hematopoietic cell transplant (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 allogeneic HCT recipients who received neuropsychological testing pretransplant and again after 80 days and one year. Age, gender and education-adjusted population-based standardized scores were used for normative comparisons. Performance on all tests declined from pretransplant to 80 days (P < .05) and improved by one year (P < .05), returning to pretransplant levels on all tests except for grip strength and motor dexterity. Although verbal fluency and memory recovered by one year, both were below norms at all three testing times (P < .01). Logistic regressions indicated that patients without chemotherapy, other than hydroxyurea, previous to HCT and patients not receiving chronic GVHD medication at one 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 pretransplant levels by one 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.
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