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Reduced-Intensity Conditioning Avoids Transplant-Associated Cognitive Decline

VBCC - Other
Phoebe Starr

New Orleans, LA—Hematopoietic stem-cell transplant (HSCT) is often the only curative therapy for some hematologic malignancies, yet this procedure is associated with cognitive decline. A new study presented at the 2013 Annual Meeting of the American Society of Hematology shows that reduced-intensity conditioning does not impact cognition, and, in fact, patients treated with reduced-intensity conditioning regimens had similar levels of cognition to those of matched healthy controls.

Another important finding of this study is the first evidence that shorter telomere length before HSCT is associated with cognitive decline in female patients. This effect was not seen in male patients. Telomere length is associated with cognitive decline in patients with Alzheimer’s disease.

“This study strongly indicates that patients who receive reduced-intensity transplants are generally spared from significant changes on their cognitive abilities, while full-intensity conditioning contributes to declines in multiple cognitive domains,” said study author Alysia Bosworth, MD, CCRP, Department of Population Sciences, City Of Hope, Duarte, CA.

Senior author, Smita Bhatia, MD, MPH, also at City of Hope, said that this study was unique in that it compared full- and reduced-intensity HSCT and also included a healthy control comparison group.

The prospective, longitudinal study assessed the trajectory of cognitive function in patients who had HSCT from before their transplant (N = 242) to 2 years after the transplant using 14 standardized neurologic tests that assessed 8 cognitive domains. Cognitive function was also assessed in 98 age- and sex-matched healthy controls at similar time points. Of the patients, 69% had leukemia. Approximately 50% of the patients received full-intensity HSCT (N = 48), and 52% received reduced-intensity conditioning.

At 2 years after transplant, 125 HSCT patients and 45 healthy controls were evaluable. Full-intensity HSCT was associated with declines in executive function, processing speed, verbal speed, and visual memory, whereas reduced-intensity HSCT did not affect these domains and patients treated with reduced-intensity HSCT had levels of cognitive function that were similar in all domains to those of the healthy controls.

Factors strongly associated with cognitive decline included full-intensity HSCT, older age, male sex, Hispanic ethnicity, low education level, income, and cognitive reserve.

Dr Bhatia and Dr Bosworth agreed that patients who are at risk for cognitive decline should be evaluated and should be offered multidisciplinary support services to help them maintain or regain cognitive function after HSCT.

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Last modified: May 28, 2014
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