Cognitive performance and mortality among patients receiving autologous hematopoietic stem cell transplant

Abstract

Objectives

Patients undergoing autologous hematopoietic stem cell transplant (HCT) are at risk for death and remain understudied relative to those undergoing allogeneic HCT. Cognitive functioning may be a useful indicator of mortality risk. We examined cognition among patients who underwent autologous HCT and its relationship to mortality.

Methods

Participants (N = 51; 11 patients deceased) completed tasks of processing speed, working memory, executive-mediated learning, and visual recall using the computerized CogState battery prior to HCT, 30 days post-autologous HCT, and 100 days post-autologous HCT.

Results

Slower processing speed (HR = 3.00) and more errors on an executive-mediated visual learning task (HR = 2.78) prior to HCT were associated with an increased risk of death following HCT. Our sample size limited longitudinal analyses of whether cognitive change predicted survival, however descriptive cognitive data of the deceased versus living patient’s performances over time suggested different patterns of performance across groups.

Conclusions

Pre-HCT cognition may have utility as an indicator of mortality risk following autologous HCT. More research is needed to examine whether cognitive changes after HCT could also predict mortality.

Keywords:

• autologous hematopoietic stem cell transplant
• cognition
• hematopoietic stem cell transplant
• mortality
• neuropsychology

Acknowledgements

We thank the research assistants for performing the cognitive testing, including Alyssa Buthman, Courtney Goetz, Mariam Ktiri, and Nicholas Scapini. We also thank the BMT physicians, Physician Assistants, and nurse coordinators from the University of Michigan’s Blood and Marrow Transplantation Program, and Lynne Bischoff, the BMT clinical research coordinator. Finally, we appreciate the time and effort provided by patients receiving HCT at Michigan Medicine.

Disclosure statement

The authors have no relevant financial or non-financial interests to disclose.

Notes

1 Higher scores on tests of processing speed represent longer response times (i.e., poorer performance) and higher scores on tests of executive-mediated learning and recall represent more errors (i.e., poorer performance). For working memory raw scores, higher scores indicate a better (i.e., more accurate) performance. Therefore, all working memory scores were reversed so that the interpretation of the direction of scores would be consistent across domains.

Additional information

Funding

The project received funding from The Blue Cross Blue Shield of Michigan Foundation (grant #: 2193.II).