We thank Jeanie Woodruff, BS, ELS, Department of Symptom Research, MD Anderson Cancer Center, for editorial assistance, and Melissa S.Y. Thong, PhD, Department of Medical Psychology and Neuropsychology, Tilburg University, The Netherlands, for assistance with data preparation for statistical analysis.
Acute cognitive impairment in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplant
Version of Record online: 16 SEP 2013
© 2013 American Cancer Society
Volume 119, Issue 23, pages 4188–4195, 1 December 2013
How to Cite
Jones, D., Vichaya, E. G., Wang, X. S., Sailors, M. H., Cleeland, C. S. and Wefel, J. S. (2013), Acute cognitive impairment in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplant. Cancer, 119: 4188–4195. doi: 10.1002/cncr.28323
This article was previously presented as an invited oral presentation at the American Society of Hematology 54th Annual Meeting and Exposition; Atlanta, GA, December 8-11, 2012.
- Issue online: 18 NOV 2013
- Version of Record online: 16 SEP 2013
- Manuscript Accepted: 23 JUL 2013
- Manuscript Revised: 21 JUN 2013
- Manuscript Received: 1 MAY 2013
- cognitive impairment;
- autologous transplant;
- multiple myeloma;
- induction chemotherapy;
- neuropsychological testing;
- patient-reported outcomes
Few studies have examined the acute effects of autologous hematopoietic stem cell transplantation (Au-HSCT) on the neuropsychological functioning of patients with multiple myeloma (MM). The prevalence of cognitive deficits after induction chemotherapy (pre-AuHSCT) was examined in patients with MM, clinically significant changes in cognitive function 1 and 3 months post-AuHSCT were determined, and patients who may be vulnerable to cognitive decline during this period were identified.
A total of 53 patients with MM were recruited pre-AuHSCT. Neuropsychological tests measuring multiple cognitive domains (attention, psychomotor speed, learning/memory, language, executive function, motor function) were administered pre-AuHSCT and 1 and 3 months post-AuHSCT. A pretreatment assessment was not available. An Overall Cognitive Function Index was computed to determine cognitive impairment pre-AuHSCT, and a practice-effect–adjusted Reliable Change Index was used to determine cognitive change over time.
Overall, deficits were more frequent in learning/memory, executive function, motor function, and psychomotor speed. Before AuHSCT, 47% of patients (25/53) exhibited cognitive impairment as determined by the Overall Cognitive Function Index. One month post-AuHSCT, 49% of patients (20/41) demonstrated clinically significant decline on 1 or more measures; 3 months post-AuHSCT, 48% (14 of 29 patients) showed decline on 1 or more measures. Older patients, minorities, and those with advanced disease, more induction cycles, or postinduction deficits showed greater vulnerability to decline.
Nearly half of the patients showed vulnerability to impairment in learning/memory or executive function after receiving induction therapy, and the prevalence of impairment remained high post-AuHSCT. Awareness of cognitive impairment and associated risk factors in actively treated patients is important for considering psychosocial or other support for patients with acute cognitive symptoms. Cancer 2013;119:4188–4195. ©2013 American Cancer Society.