Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years

Karen L. Syrjala, Samantha B. Artherholt, Brenda F. Kurland, Shelby Langer, Sari Roth-Roemer, JoAnn Broeckel Elrod, Sureyya Dikmen

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Purpose: Research has documented cognitive deficits both before and after high-dose treatment followed by allogeneic hematopoietic cell transplantation (HCT), with partial recovery by 1 year. This study prospectively examined the trajectory and extent of long-term cognitive dysfunction, with a focus on 1 to 5 years after treatment. Patients and Methods: Allogeneic HCT recipients completed standardized neuropsychological tests including information processing speed (Trail Making A and Digit Symbol Substitution Test), verbal memory (Hopkins Verbal Learning Test-Revised), executive function (Controlled Oral Word Association Test and Trail Making B), and motor dexterity and speed (Grooved Pegboard). Survivors (n = 92) were retested after 80 days and 1 and 5 years after transplantation. Case-matched controls (n = 66) received testing at the 5-year time point. A Global Deficit Score (GDS) summarized overall impairment. Response profiles were analyzed using linear mixed effects models. Results: Survivors recovered significant cognitive function from post-transplantation (80 days) to 5 years in all tests (P < .0001) except verbal recall (P > .06). Between 1 and 5 years, verbal fluency improved (P = .0002), as did executive function (P < .01), but motor dexterity did not (P > .15), remaining below controls (P < .0001) and more than 0.5 standard deviation below population norms. In GDS, 41.5% of survivors and 19.7% of controls had mild or greater deficits (NcNemar test = 7.04, P = .007). Conclusion: Although neurocognitive function improved from 1 to 5 years after HCT, deficits remained for more than 40% of survivors. Risk factors, mechanisms and rehabilitation strategies need to be identified for these residual deficits.

Original languageEnglish (US)
Pages (from-to)2397-2404
Number of pages8
JournalJournal of Clinical Oncology
Volume29
Issue number17
DOIs
StatePublished - Jun 10 2011
Externally publishedYes

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Cell Transplantation
Survivors
Executive Function
Neoplasms
Word Association Tests
Transplantation
Verbal Learning
Neuropsychological Tests
Automatic Data Processing
Cognition
Rehabilitation
Therapeutics
Research
Population

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. / Syrjala, Karen L.; Artherholt, Samantha B.; Kurland, Brenda F.; Langer, Shelby; Roth-Roemer, Sari; Elrod, JoAnn Broeckel; Dikmen, Sureyya.

In: Journal of Clinical Oncology, Vol. 29, No. 17, 10.06.2011, p. 2397-2404.

Research output: Contribution to journalArticle

Syrjala, Karen L. ; Artherholt, Samantha B. ; Kurland, Brenda F. ; Langer, Shelby ; Roth-Roemer, Sari ; Elrod, JoAnn Broeckel ; Dikmen, Sureyya. / Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 17. pp. 2397-2404.
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AU - Syrjala, Karen L.

AU - Artherholt, Samantha B.

AU - Kurland, Brenda F.

AU - Langer, Shelby

AU - Roth-Roemer, Sari

AU - Elrod, JoAnn Broeckel

AU - Dikmen, Sureyya

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AB - Purpose: Research has documented cognitive deficits both before and after high-dose treatment followed by allogeneic hematopoietic cell transplantation (HCT), with partial recovery by 1 year. This study prospectively examined the trajectory and extent of long-term cognitive dysfunction, with a focus on 1 to 5 years after treatment. Patients and Methods: Allogeneic HCT recipients completed standardized neuropsychological tests including information processing speed (Trail Making A and Digit Symbol Substitution Test), verbal memory (Hopkins Verbal Learning Test-Revised), executive function (Controlled Oral Word Association Test and Trail Making B), and motor dexterity and speed (Grooved Pegboard). Survivors (n = 92) were retested after 80 days and 1 and 5 years after transplantation. Case-matched controls (n = 66) received testing at the 5-year time point. A Global Deficit Score (GDS) summarized overall impairment. Response profiles were analyzed using linear mixed effects models. Results: Survivors recovered significant cognitive function from post-transplantation (80 days) to 5 years in all tests (P < .0001) except verbal recall (P > .06). Between 1 and 5 years, verbal fluency improved (P = .0002), as did executive function (P < .01), but motor dexterity did not (P > .15), remaining below controls (P < .0001) and more than 0.5 standard deviation below population norms. In GDS, 41.5% of survivors and 19.7% of controls had mild or greater deficits (NcNemar test = 7.04, P = .007). Conclusion: Although neurocognitive function improved from 1 to 5 years after HCT, deficits remained for more than 40% of survivors. Risk factors, mechanisms and rehabilitation strategies need to be identified for these residual deficits.

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