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. 2022 Jun;16(3):696-704.
doi: 10.1007/s11764-021-01063-1. Epub 2021 Jun 4.

Long-term neurocognitive and quality of life outcomes in survivors of pediatric hematopoietic cell transplant

Natalie L Wu  1   2 , Kevin R Krull  3 , Kara L Cushing-Haugen  4 , Nicole J Ullrich  5 , Nina S Kadan-Lottick  6 , Stephanie J Lee  4 , Eric J Chow  7   4
Affiliations

Long-term neurocognitive and quality of life outcomes in survivors of pediatric hematopoietic cell transplant

Natalie L Wu et al. J Cancer Surviv. 2022 Jun.

Abstract

Purpose: Pediatric patients who undergo hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can impact quality of life. Given limited long-term studies, we aimed to characterize the late neurocognitive outcomes in a cohort of pediatric HCT survivors.

Methods: Eligible survivors (HCT at age < 21 year and ≥ 1 year post-HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) and the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL). Analyses of risk factors included univariate comparisons and multivariable logistic regression.

Results: Participants (n = 199, 50.3% female, 53.3% acute leukemia, 87.9% allogeneic transplants) were surveyed at median age of 37.8 years (interquartile range [IQR] 28.5-48.8) at survey and median 27.6 years (IQR 17.0-34.0) from transplant. On the CCSS-NCQ, 18.9-32.5% of survivors reported impairments (Z score > 1.28) in task efficiency, memory, emotional regulation, or organization, compared with expected 10% in the general population (all p < 0.01). In contrast, survivors reported average Neuro-QoL (T score 49.6±0.7) compared with population normative value of 50 (p = 0.52). In multivariable regression, impaired Neuro-QoL (T score < 40) was independently associated with hearing issues (OR 4.97, 95% CI 1.96-12.6), history of stroke or seizure (OR 4.46, 95% CI 1.44-13.8), and sleep disturbances (OR 6.95, 95% CI 2.53-19.1).

Conclusions: Although long-term survivors of pediatric HCT reported higher rates of impairment in specific neurocognitive domains, cognitive quality of life was perceived as similar to the general population. Subsets of survivors with certain co-morbidities had substantially worse neurocognitive outcomes.

Implications for cancer survivors: While the long-term impact of pediatric HCT can include neurocognitive deficits, survivors report average cognitive quality of life.

Keywords: Late effects; Neurocognitive; Quality of life; Stem cell transplantation.

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Conflict of interest statement

Conflicts of interest/Competing interests

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

Figures

FIGURE 1
FIGURE 1
Risk of impairment (CCSS-NCQ domains, closed symbols; NeuroQoL, open circles) associated with selected exposures and co-morbidities using multivariable logistic regression* *Horizontal error bars represent 95% confidence interval; error bar not overlapping with Odds Ratio = 1 indicates significant impairment
See this image and copyright information in PMC

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