Mental Status Changes after Hematopoietic Stem Cell Transplantation

Background—The growing numbers of survivors of innovative cancer treatments such as hematopoietic stem cell transplantation (HSCT) often report subsequent cognitive difficulties. The purpose of this study is to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia (CML) or primary myelodysplastic syndrome (MDS) after allogeneic HSCT or other therapies. Methods—Prospective cohort study employing serial evaluations of attention, concentration, memory, mood and quality of life in a consecutive sample of 106 eligible patients with CML (n=91) or MDS (n=15) at enrollment, and then 12 and 18 months after HSCT or other therapy. Results—The three evaluations were completed by 98%, 95%, and 89% of surviving participants, respectively. Among all patients, there was significant improvement in memory over 18 months. For example, the 45 people receiving HSCT (42 with CML, 3 with MDS) compared favorably to those who had other treatment on most measures of neuropsychological function, except they had improved mental health (p=.034), worse physical function (p=.049), and more difficulty with coordination and fine motor speed bilaterally (dominant, p=.005, and non-dominant hands, p=.0019). CML patients overall had improved phonemic fluency (p=.014). Conclusions—Time and diagnosis may be important factors when assessing neurocognitive and other changes. Complaints about “chemobrain” following HSCT merit further study, as deficits may actually pre-date initiation of treatment and then subsequently improve. Study results could reassure prospective HSCT recipients since it compares favorably to other treatments when mental status side effects are considered.