Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida.
Department of Psychology, University of South Florida, Tampa, Florida.
Biol Blood Marrow Transplant. 2017 Nov;23(11):1974-1979. doi: 10.1016/j.bbmt.2017.08.006. Epub 2017 Aug 7.
Improvements in supportive care have enabled allogeneic hematopoietic cell transplantation (HCT) to be performed in increasingly older patients. HCT is associated with neurocognitive impairment, which may be exacerbated in older adults due to normal neurocognitive decline associated with aging. The goal of this study was to evaluate whether increasing age of allogeneic HCT recipients is associated with worse neurocognitive outcomes over time relative to a matched sample of individuals without cancer. Patients (n = 140; 42% female; M age, 51 years; range, 20 to 76 years; 31% with acute myelogenous leukemia) completed neurocognitive assessments before transplantation and 3 months and 1 year after transplantation. Controls (n = 75; 56% female; M age, 53 years; range, 21 to 74 years) completed assessments at comparable time intervals. Linear mixed models revealed that regardless of age, patients demonstrated worse performance than controls before transplantation in verbal memory, visual memory, and total neuropsychological performance, and over time in executive functioning. In addition, older age was associated with worse performance in verbal memory (P = .02) and verbal fluency (P = .05) over time in patients compared with controls. Specifically, older (65+ years) patients had worse verbal memory and verbal fluency than older and younger (<65 years) controls post-transplantation (Cohen's d = .22 to .39). These data indicate that age may be a risk factor for worse neurocognitive outcomes after allogeneic HCT. If replicated, our results suggest that older candidates for allogeneic HCT should be counseled regarding the risk of cognitive problems after transplantation.
支持性治疗的改善使得异基因造血细胞移植（HCT）能够在年龄越来越大的患者中进行。HCT 与神经认知障碍有关，由于与衰老相关的正常神经认知下降，老年人的认知障碍可能会加剧。本研究的目的是评估异基因 HCT 受者的年龄增加是否与相对于无癌症的匹配个体的神经认知结果随时间恶化相关。患者（n=140；42%为女性；M 年龄，51 岁；范围，20 至 76 岁；31%为急性髓细胞性白血病）在移植前、移植后 3 个月和 1 年完成神经认知评估。对照组（n=75；56%为女性；M 年龄，53 岁；范围，21 至 74 岁）在可比的时间间隔内完成评估。线性混合模型显示，无论年龄如何，患者在移植前的言语记忆、视觉记忆和总神经心理表现方面的表现均差于对照组，且随着时间的推移，执行功能也会恶化。此外，与对照组相比，年龄较大（65 岁以上）的患者在言语记忆（P=.02）和言语流畅性（P=.05）方面的表现随着时间的推移而恶化。具体而言，与移植后年龄较大（65 岁以上）和年龄较小（<65 岁）的对照组相比，年龄较大（65 岁以上）的患者的言语记忆和言语流畅性较差（Cohen's d=0.22 至 0.39）。这些数据表明，年龄可能是异基因 HCT 后神经认知结果恶化的一个危险因素。如果得到复制，我们的结果表明，对于异基因 HCT 的老年候选者，应告知他们移植后认知问题的风险。
