Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Support Care Cancer. 2021 May;29(5):2621-2630. doi: 10.1007/s00520-020-05761-x. Epub 2020 Sep 23.
Survivors of allogeneic hematopoietic stem cell transplantation (alloHCT) may experience cognitive impairment over time post-treatment, but early identification of these individuals is limited.
We previously reported a prospective evaluation of cognitive functioning over the first 6 months of alloHCT. Here, we report an extension of this study, with specific aims to (1) evaluate the trajectory of cognitive outcomes over the first 6 years post-alloHCT, and (2) determine the extent to which late cognitive impairment is predicted by earlier impairment.
Participants completed objective and subjective cognitive measures before alloHCT, and at 100 days, 6 months, and 6 years post-alloHCT. Outcome trajectories were determined using linear mixed effects models. Relationships between early and late cognitive impairment were assessed using logistic regression and receiver operator curves.
This analysis is based on longitudinal data from 59 participants, of whom 20 provided data at 6-year follow-up. Longitudinal models revealed an overall stability of cognitive outcomes over time, except for psychomotor efficiency/processing speed performance, which significantly improved (p = .049). However, poor learning/memory and cognitive complaints were persistently observed. At 6 years, 40% of relapse-free survivors met the impairment criteria. Impairment at 100 days was associated with impairment 6 years (OR = 20.00, p = .028) and demonstrated good accuracy in classifying those who were impaired and not impaired at 6 years (AUC = .79; 95% CI = .56-1.00).
Poor cognitive outcomes among long-term alloHCT survivors are associated with cognitive functioning during the early post-treatment period. Early identification of survivors likely to experience poor cognitive outcomes may be possible, enabling timely intervention to mitigate long-term negative impacts.
异基因造血干细胞移植（alloHCT）后的幸存者可能会随着时间的推移出现认知障碍，但早期识别这些个体的方法有限。
我们之前报告了一项对 alloHCT 后前 6 个月认知功能的前瞻性评估。在此，我们报告了该研究的扩展，具体目标是：（1）评估 alloHCT 后前 6 年认知结果的轨迹；（2）确定早期认知障碍对晚期认知障碍的预测程度。
参与者在 alloHCT 前、100 天时、6 个月和 6 年后完成客观和主观认知测量。使用线性混合效应模型确定结果轨迹。使用逻辑回归和接收者操作特征曲线评估早期和晚期认知障碍之间的关系。
该分析基于 59 名参与者的纵向数据，其中 20 名参与者在 6 年随访时提供了数据。纵向模型显示认知结果总体上随时间稳定，除了精神运动效率/处理速度表现有所改善（p =.049）。然而，持续观察到学习/记忆和认知主诉较差。在 6 年时，40%的无复发幸存者符合损伤标准。100 天时的损伤与 6 年时的损伤相关（OR = 20.00，p =.028），并在分类 6 年时损伤和未损伤的个体方面具有良好的准确性（AUC =.79；95%CI =.56-1.00）。
长期 alloHCT 幸存者的认知结果较差与治疗后早期的认知功能有关。可能有可能早期识别出可能出现认知障碍的幸存者，从而及时进行干预以减轻长期的负面影响。
