Ho Mu-Hsing, Cheung Denise Shuk Ting, Wang Tongyao, Wang Lizhen, Wong Justin Wei Ho, Lin Chia-Chin
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, Hong Kong SAR.
Alice Ho Miu Ling Nethersole Charity Foundation, Tai Po, New Territories, Hong Kong.
Support Care Cancer. 2025 Mar 22;33(4):312. doi: 10.1007/s00520-025-09356-2.
Cancer-related cognitive impairment is one of the symptoms of neurotoxicity among patients receiving chimeric antigen receptor (CAR) T cell therapy. Evidence of the overall estimated prevalence of cancer-related cognitive impairment following CAR T-cell therapy among patients with hematologic malignancies at short-term and long-term follow-ups is lacking. This review aimed to summarize the cognitive functioning status and estimate the prevalence of cancer-related cognitive impairment at follow-up within 1 month, 1 to 12 months, and > 12 months after CAR T cell therapy.
PubMed, Cochrane Library, EMBASE, CINAHL Plus, Web of Science, and PsycINFO via ProQuest from inception through August 2024. Studies that reported on cognitive impairment among patients receiving CAR T cell therapy with valid measures were included. Data on cognitive impairment prevalence were pooled using a random-effects model.
In total, 16 studies involving 1407 patients were included. The pooled cancer-related cognitive impairment prevalence rates assessed using neuropsychological tests at the follow-up timepoints (< 1 month, 1-12 months, and > 12 months) were 24% [95% prediction interval (PI) 16-33%], 33% (95%, PI 9-64%), and 35% (95%, PI 23-48%), respectively. The prevalence estimates assessed using other measures were ranging from 4 to 38% across different timepoints. The leave-one-out meta-analyses quantified the impact of these potential outliers on the estimation of the overall prevalence.
The findings stress the importance of developing targeted interventions to prevent or manage cognitive impairment in cancer patients during both short-term and long-term follow-up periods. This review also highlights the need for further research in this area to improve our understanding of the disease mechanisms and implement preventive strategies for managing cancer-related cognitive impairment.
癌症相关认知障碍是接受嵌合抗原受体（CAR）T细胞治疗患者神经毒性的症状之一。缺乏血液系统恶性肿瘤患者接受CAR T细胞治疗后短期和长期随访中癌症相关认知障碍总体估计患病率的证据。本综述旨在总结认知功能状态，并估计CAR T细胞治疗后1个月内、1至12个月以及超过12个月随访时癌症相关认知障碍的患病率。
通过ProQuest检索PubMed、Cochrane图书馆、EMBASE、CINAHL Plus、Web of Science和PsycINFO，检索时间从数据库建立至2024年8月。纳入报告接受CAR T细胞治疗患者认知障碍且测量方法有效的研究。使用随机效应模型汇总认知障碍患病率数据。
共纳入16项研究，涉及1407例患者。在随访时间点（<1个月、1至12个月和>12个月）使用神经心理学测试评估的合并癌症相关认知障碍患病率分别为24%[95%预测区间（PI）16 - 33%]、33%（95%，PI 9 - 64%）和35%（95%，PI 23 - 48%）。使用其他测量方法评估的患病率估计在不同时间点为4%至38%。逐一剔除法荟萃分析量化了这些潜在异常值对总体患病率估计的影响。
研究结果强调了制定针对性干预措施以预防或管理癌症患者短期和长期随访期间认知障碍的重要性。本综述还强调了该领域进一步研究的必要性，以增进我们对疾病机制的理解，并实施管理癌症相关认知障碍的预防策略。
