%0 Journal Article %J J Clin Oncol %D 2011 %T Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. %A Syrjala, Karen L %A Artherholt, Samantha B %A Kurland, Brenda F %A Langer, Shelby L %A Roth-Roemer, Sari %A Elrod, JoAnn Broeckel %A Dikmen, Sureyya %K Adult %K Aged %K Cognition Disorders %K Female %K Hematopoietic Stem Cell Transplantation %K Humans %K Male %K Middle Aged %K Neoplasms %K Prospective Studies %K Survivors %K Time Factors %K Transplantation, Homologous %X

PURPOSE: Research has documented cognitive deficits both before and after high-dose treatment followed by allogeneic hematopoietic cell transplantation (HCT), with partial recovery by 1 year. This study prospectively examined the trajectory and extent of long-term cognitive dysfunction, with a focus on 1 to 5 years after treatment.

PATIENTS AND METHODS: Allogeneic HCT recipients completed standardized neuropsychological tests including information processing speed (Trail Making A and Digit Symbol Substitution Test), verbal memory (Hopkins Verbal Learning Test-Revised), executive function (Controlled Oral Word Association Test and Trail Making B), and motor dexterity and speed (Grooved Pegboard). Survivors (n = 92) were retested after 80 days and 1 and 5 years after transplantation. Case-matched controls (n = 66) received testing at the 5-year time point. A Global Deficit Score (GDS) summarized overall impairment. Response profiles were analyzed using linear mixed effects models.

RESULTS: Survivors recovered significant cognitive function from post-transplantation (80 days) to 5 years in all tests (P < .0001) except verbal recall (P > .06). Between 1 and 5 years, verbal fluency improved (P = .0002), as did executive function (P < .01), but motor dexterity did not (P > .15), remaining below controls (P < .0001) and more than 0.5 standard deviation below population norms. In GDS, 41.5% of survivors and 19.7% of controls had mild or greater deficits (NcNemar test = 7.04, P = .007).

CONCLUSION: Although neurocognitive function improved from 1 to 5 years after HCT, deficits remained for more than 40% of survivors. Risk factors, mechanisms and rehabilitation strategies need to be identified for these residual deficits.

%B J Clin Oncol %V 29 %P 2397-404 %8 2011 Jun 10 %G eng %N 17 %R 10.1200/JCO.2010.33.9119