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Quality of Life

A systematic review and meta-analysis of changes in cognitive functioning in adults undergoing hematopoietic cell transplantation

Bone Marrow Transplantation volume 48, pages 1350–1357 (2013)Cite this article

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Abstract

Evidence is mixed regarding the effects of hematopoietic cell transplantation (HCT) on changes in cognitive functioning among adults. Meta-analysis, which is designed to help reconcile conflicting findings, has not yet been conducted on studies of adults receiving HCT. To fill this gap, the current study provides a systematic review and meta-analysis of cognitive functioning in adults receiving HCT. A search of PubMed, PsycInfo, CINAHL, and Cochrane Library yielded 732 abstracts, which were independently evaluated by pairs of raters. Seventeen studies were systematically reviewed; 11 were retained for meta-analysis. There was agreement that cognitive impairments are evident for a subset of patients before HCT. Meta-analytical findings of 404 patients revealed no significant changes in cognitive functioning pre- to post HCT (P-values >0.05). Age, time since transplant and TBI were not associated with changes in cognitive functioning. Patients who received autologous transplants were more likely to demonstrate improvements in attention (P=0.004). The systematic review identified several limitations of existing literature, including small, clinically heterogeneous samples. Large, cooperative group studies are needed to address these design limitations. Nevertheless, results from the current meta-analysis suggest that cognitive functioning does not significantly change following HCT.

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References

  1. Pasquini M, Wang Z Current use and outcome of hematopoietic stem cell transplantation: CIBMTR Summary Slides 2011.

  2. Ahles TA, Saykin AJ, Noll WW, Furstenberg CT, Guerin S, Cole B et al. The relationship of APOE genotype to neuropsychological performance in long-term cancer survivors treated with standard dose chemotherapy. Psycho-oncology 2003; 12: 612–619.

    Article  Google Scholar 

  3. Ahles TA, Saykin A . Cognitive effects of standard-dose chemotherapy in patients with cancer. Cancer Invest 2001; 19: 812–820.

    Article  CAS  Google Scholar 

  4. Fliessbach K, Helmstaedter C, Urbach H, Althaus A, Pels H, Linnebank M et al. Neuropsychological outcome after chemotherapy for primary CNS lymphoma: a prospective study. Neurology 2005; 64: 1184–1188.

    Article  CAS  Google Scholar 

  5. de Brabander C, Cornelissen J, Smitt PA, Vecht CJ, van den Bent MJ . Increased incidence of neurological complications in patients receiving an allogenic bone marrow transplantation from alternative donors. J Neurol Neurosurg Psychiatry 2000; 68: 36–40.

    Article  CAS  Google Scholar 

  6. Fann JR, Alfano CM, Roth-Roemer S, Katon WJ, Syrjala KL . Impact of delirium on cognition, distress, and health-related quality of life after hematopoietic stem-cell transplantation. J Clin Oncol 2007; 25: 1223–1231.

    Article  Google Scholar 

  7. Andrykowski MA, Cordova MJ, Hann DM, Jacobsen PB, Fields KK, Phillips G . Patients' psychosocial concerns following stem cell transplantation. Bone Marrow Transplant 1999; 24: 1121–1129.

    Article  CAS  Google Scholar 

  8. Booth-Jones M, Jacobsen PB, Ransom S, Soety E . Characteristics and correlates of cognitive functioning following bone marrow transplantation. Bone Marrow Transplant 2005; 36: 695–702.

    Article  CAS  Google Scholar 

  9. Heinonen H, Volin L, Zevon MA, Uutela A, Barrick C, Ruutu T . Stress among allogeneic bone marrow transplantation patients. Patient Educ Couns 2005; 56: 62–71.

    Article  Google Scholar 

  10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine 2009; 6: e1000100.

    Article  Google Scholar 

  11. Lezak MD, Howieson DB, Loring DW . Neuropsychological Assessment 4 edn. Oxford University Press: New York, NY, USA, 2004.

    Google Scholar 

  12. Hedges L, Olkin I . Statistical Methods for Meta-analysis. Academic Press: San Diego, CA, USA, 1985.

    Google Scholar 

  13. Beglinger LJ, Mills JA, Vik SM, Duff K, Denburg NL, Weckmann MT et al. The neuropsychological course of acute delirium in adult hematopoietic stem cell transplantation patients. Arch Clin Neuropsychol 2011; 26: 98–109.

    Article  Google Scholar 

  14. Borenstein M, Hedges L, Higgins J et al Introduction to meta-analysis. John Wiley & Sons, Ltd.: Chichester, West Sussex, UK, 2009.

    Book  Google Scholar 

  15. Andrykowski MA, Schmitt FA, Gregg ME, Brady MJ, Lamb DG, Henslee-Downey PJ . Neuropsychologic impairment in adult bone marrow transplant candidates. Cancer 1992; 70: 2288–2297.

    Article  CAS  Google Scholar 

  16. Harder H, Cornelissen JJ, Van Gool AR, Duivenvoorden HJ, Eijkenboom WM, van den Bent MJ . Cognitive functioning and quality of life in long-term adult survivors of bone marrow transplantation. Cancer 2002; 95: 183–192.

    Article  Google Scholar 

  17. Peper M, Steinvorth S, Schraube P, Fruehauf S, Haas R, Kimmig BN et al. Neurobehavioral toxicity of total body irradiation: a follow-up in long-term survivors. Int J Radiat Oncol Biol Phys 2000; 46: 303–311.

    Article  CAS  Google Scholar 

  18. Poppelreuter M, Weis J, Mumm A, Orth HB, Bartsch HH . Rehabilitation of therapy-related cognitive deficits in patients after hematopoietic stem cell transplantation. Bone Marrow Transplant 2008; 41: 79–90.

    Article  CAS  Google Scholar 

  19. Ahles TA, Tope DM, Furstenberg C, Hann D, Mills L . Psychologic and neuropsychologic impact of autologous bone marrow transplantation. J Clin Oncol 1996; 14: 1457–1462.

    Article  CAS  Google Scholar 

  20. Syrjala KL, Artherholt SB, Kurland BF, Langer SL, Roth-Roemer S, Elrod JB et al. Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. J Clin Oncol 2011; 29: 2397–2404.

    Article  Google Scholar 

  21. Jacobs SR, Small BJ, Booth-Jones M, Jacobsen PB, Fields KK . Changes in cognitive functioning in the year after hematopoietic stem cell transplantation. Cancer 2007; 110: 1560–1567.

    Article  Google Scholar 

  22. Sostak P, Padovan CS, Yousry TA, Ledderose G, Kolb HJ, Straube A . Prospective evaluation of neurological complications after allogeneic bone marrow transplantation. Neurology 2003; 60: 842–848.

    Article  CAS  Google Scholar 

  23. Beglinger LJ, Duff K, Van Der Heiden S, Moser DJ, Bayless JD, Paulsen JS et al. Neuropsychological and psychiatric functioning pre- and posthematopoietic stem cell transplantation in adult cancer patients: a preliminary study. J Int Neuropsychol Soc 2007; 13: 172–177.

    Article  Google Scholar 

  24. Chang G, Meadows ME, Orav EJ, Antin JH . Mental status changes after hematopoietic stem cell transplantation. Cancer 2009; 115: 4625–4635.

    Article  Google Scholar 

  25. Friedman MA, Fernandez M, Wefel JS, Myszka KA, Champlin RE, Meyers CA . Course of cognitive decline in hematopoietic stem cell transplantation: a within-subjects design. Arch Clin Neuropsychol 2009; 24: 689–698.

    Article  Google Scholar 

  26. Harder H, Duivenvoorden HJ, van Gool AR, Cornelissen JJ, van den Bent MJ . Neurocognitive functions and quality of life in haematological patients receiving haematopoietic stem cell grafts: a one-year follow-up pilot study. J Clin Exp Neuropsychol 2006; 28: 283–293.

    Article  Google Scholar 

  27. Harder H, Van Gool AR, Duivenvoorden HJ, Cornelissen JJ, Eijkenboom WM, Barge RM et al. Case-referent comparison of cognitive functions in patients receiving haematopoietic stem-cell transplantation for haematological malignancies: two-year follow-up results. Eur J Cancer 2007; 43: 2052–2059.

    Article  Google Scholar 

  28. Schulz-Kindermann F, Mehnert A, Scherwath A, Schirmer L, Schleimer B, Zander AR et al. Cognitive function in the acute course of allogeneic hematopoietic stem cell transplantation for hematological malignancies. Bone Marrow Transplant 2007; 39: 789–799.

    Article  CAS  Google Scholar 

  29. Wenz F, Steinvorth S, Lohr F, Fruehauf S, Wildermuth S, van Kampen M et al. Prospective evaluation of delayed central nervous system (CNS) toxicity of hyperfractionated total body irradiation (TBI). Int J Radiat Oncol Biol Phys 2000; 48: 1497–1501.

    Article  CAS  Google Scholar 

  30. Fann JR, Roth-Roemer S, Burington BE, Katon WJ, Syrjala KL . Delirium in patients undergoing hematopoietic stem cell transplantation. Cancer 2002; 95: 1971–1981.

    Article  Google Scholar 

  31. Harder H, Van Gool AR, Cornelissen JJ, Duivenvoorden HJ, Eijkenboom WM, Barge RM et al. Assessment of pre-treatment cognitive performance in adult bone marrow or haematopoietic stem cell transplantation patients: a comparative study. Eur J Cancer 2005; 41: 1007–1016.

    Article  Google Scholar 

  32. Syrjala KL, Dikmen S, Langer SL, Roth-Roemer S, Abrams JR . Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant. Blood 2004; 104: 3386–3392.

    Article  CAS  Google Scholar 

  33. Wefel JS, Vardy J, Ahles T, Schagen SB . International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 2011; 12: 703–708.

    Article  Google Scholar 

  34. Saykin AJ, Ahles TA, McDonald BC . Mechanisms of chemotherapy-induced cognitive disorders: neuropsychological, pathophysiological, and neuroimaging perspectives. Semin Clin Neuropsychiatry 2003; 8: 201–216.

    Article  Google Scholar 

  35. Ahles TA, Saykin AJ, McDonald BC, Li Y, Furstenberg CT, Hanscom BS et al. Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Oncol 2010; 28: 4434–4440.

    Article  Google Scholar 

  36. Scherwath A, Schirmer L, Kruse M, Ernst G, Eder M, Dinkel A et al. Cognitive functioning in allogeneic hematopoietic stem cell transplantation recipients and its medical correlates: a prospective multicenter study. Psycho-oncology, (e-pub ahead of print 4 September 2012).

  37. Skucek E, Butler S, Gaspar HB, Titman P . Social outcome in children treated by haematopoietic cell transplant for congenital immunodeficiency. Bone Marrow Transplant 2011; 46: 1314–1320.

    Article  CAS  Google Scholar 

  38. Packman W, Weber S, Wallace J, Bugescu N . Psychological effects of hematopoietic SCT on pediatric patients, siblings and parents: a review. Bone Marrow Transplant 2010; 45: 1134–1146.

    Article  CAS  Google Scholar 

  39. Kohli S, Fisher SG, Tra Y, Adams MJ, Mapstone ME, Wesnes KA et al. The effect of modafinil on cognitive function in breast cancer survivors. Cancer 2009; 115: 2605–2616.

    Article  CAS  Google Scholar 

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Acknowledgements

HJ is supported, in part, by K07-CA138499.

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Authors and Affiliations

  1. Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA

    K M Phillips, M G Cases, P B Jacobsen & H S L Jim

  2. Department of Psychology, University of South Florida, Tampa, FL, USA

    H L McGinty, J Cessna, Y Asvat, B Gonzalez & B J Small

  3. Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA

    J Pidala

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  1. K M Phillips
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Correspondence to H S L Jim.

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Phillips, K., McGinty, H., Cessna, J. et al. A systematic review and meta-analysis of changes in cognitive functioning in adults undergoing hematopoietic cell transplantation. Bone Marrow Transplant 48, 1350–1357 (2013). https://doi.org/10.1038/bmt.2013.61

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