Division of Hematology/Oncology, Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, Oakland, CA.
Department of Epidemiology, University of Washington, Seattle, WA.
Blood Adv. 2022 Jul 26;6(14):4347-4356. doi: 10.1182/bloodadvances.2021006672.
Survivors of hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can negatively affect quality of life. Given limited studies, we aimed to describe the neurocognitive outcomes in a cohort of long-term adult HCT survivors. Eligible survivors (age ≥21 years at HCT and alive ≥2 years following HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL) and the Childhood Cancer Survivor Study Neurocognitive Questionnaire (NCQ). Analyses of risk factors included univariate comparisons and multivariable logistic regression. Survivors (n = 1861, 47.7% female, 65.6% allogeneic HCT) were surveyed at a median age of 64.2 years (interquartile range [IQR], 56.8-70.5) and a median 12.0 years (IQR, 6.0-21.0) from HCT. Survivors reported average Neuro-QoL scores (50.0 allogeneic; 49.2 autologous survivors) compared with an expected mean of 50 in the general population. On the NCQ, 17.4% to 31.2% of survivors reported impairments (Z-score >1.28) in task efficiency, memory, emotional regulation, or organization, compared with an expected 10% in the general population (all P < .01). In multivariable regression analyses, impaired Neuro-QoL (T-score <40) was independently associated with hearing issues (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.46-3.10) and sleep impairment (OR, 4.41; 95% CI, 2.80-6.94) among allogeneic survivors, with comparable associations in autologous survivors. Overall, long-term adult HCT survivors reported average cognitive quality of life compared with the general population. Subsets of survivors with hearing issues and sleep impairments were more likely to report lower quality of life and impaired neurocognitive function, which may facilitate targeted monitoring or interventions following HCT.
造血细胞移植（HCT）幸存者存在神经认知障碍风险，这可能会对生活质量产生负面影响。鉴于研究有限，我们旨在描述一组长期成人 HCT 幸存者的神经认知结果。符合条件的幸存者（HCT 时年龄≥21 岁，HCT 后≥2 年仍存活）完成了 60 个问题的神经认知功能和生活质量调查，其中包括神经生活质量认知功能简明量表（Neuro-QoL）和儿童癌症幸存者研究神经认知问卷（NCQ）。风险因素分析包括单变量比较和多变量逻辑回归。在中位年龄为 64.2 岁（四分位距[IQR]，56.8-70.5）和中位 HCT 后 12.0 年（IQR，6.0-21.0）时，对 1861 名幸存者（47.7%为女性，65.6%为异基因 HCT）进行了调查。幸存者报告的平均神经生活质量评分（50.0 例异基因；49.2 例自体幸存者）与一般人群预期的 50 分相近。在 NCQ 上，17.4%至 31.2%的幸存者报告在任务效率、记忆、情绪调节或组织方面存在障碍（Z 评分>1.28），而一般人群中预期为 10%（均 P<.01）。在多变量回归分析中，与一般人群相比，神经生活质量评分受损（T 评分<40）在异基因幸存者中与听力问题（优势比[OR]，2.13；95%置信区间[CI]，1.46-3.10）和睡眠障碍（OR，4.41；95%CI，2.80-6.94）独立相关，在自体幸存者中也存在类似的关联。总体而言，长期成人 HCT 幸存者的认知生活质量与一般人群相近。有听力问题和睡眠障碍的幸存者亚组更有可能报告生活质量较低和神经认知功能受损，这可能有助于在 HCT 后进行有针对性的监测或干预。
