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Quality of Life in Long-Term Survivors of HCT Similar to General Population

July 26, 2022

August 2022

Long-term survivors of hematopoietic cell transplant (HCT) reported a quality-of-life (QoL) on par with that of the general population, according to a study in Blood Advances. While neurocognitive issues continue to be a long-term concern, study author Natalie L. Wu, MD, of the University of California, San Francisco, called this finding “reassuring.”

“There is still a lot to learn about the long-term effects of HCT,” she said. “Specifically for neurocognitive outcomes, there have been mixed results in previous studies, so it was not entirely surprising to find that survivors reported average cognitive QoL.”

Dr. Wu and colleagues studied patients who underwent HCT for malignant and non-malignant conditions at the Fred Hutchinson Cancer Research Center, which maintains continuous follow-up of HCT survivors through an annual patient-reported health survey. Survivors were eligible if they were alive two or more years after HCT, were age 21 or older at the time of transplant, and had a current mailing address available. Those who were eligible completed a 60-question survey of neurocognitive function and QoL. Of 3,521 eligible adults, 52.9% (n=1,862) with a median time of 12 years from transplant (interquartile range [IQR] 6.0-21.0) participated.

Most respondents (89.2%) were white, with a median age of 64.2 years (IQR 56.8-70.5). Among respondents, 65.6% underwent allogeneic HCT (alloHCT) and 47.9% underwent conditioning with total body irradiation, with 29.5% receiving 1,000 cGy or more. Additionally, two-thirds of respondents (66.6%) who underwent alloHCT reported a diagnosis of chronic graft-versus-host disease.

“While survivors reported average QoL, they also reported persistent impairments in specific neurocognitive domains, such as memory and organization,” Dr. Wu said. “This may reflect the resiliency of survivors to adapt to these deficiencies and minimize their impact on QoL.”

While neurocognitive issues continue to be a long-term concern, Dr. Wu called this finding “reassuring.”

Long-term survivors had average Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL) scores: 50.0 for alloHCT and 49.2 for autologous HCT (AHCT) survivors. The expected mean in the general population is 50. On the Childhood Cancer Survivor Study Neurocognitive Questionnaire (NCQ), about one-third of survivors (31.2%) reported impairments in task efficiency, memory, emotional regulation, or organization compared with an expectation of about 10% in the general population (p<0.01 for all).

“We found that certain subsets of HCT survivors were more likely to report lower QoL and neurocognitive dysfunction, including those with hearing issues or sleep problems,” Dr. Wu said. “For our group, one of the more notable results was the association of impaired sleep with poor neurocognitive outcomes, which reinforces the importance of early identification of and intervention on sleep issues.”

A multivariable analysis showed that impaired Neuro-QoL among alloHCT survivors was independently associated with hearing issues (odds ratio [OR] = 2.13, 95% CI 1.46-3.10) and sleep impairment (OR=4.41, 95% CI 2.80-9.94). Similar associations were seen in AHCT survivors.

Overall, older age was consistently associated with greater cognitive QoL and fewer impairments in specific neurocognitive domains, according to Dr. Wu. However, in their discussion of the results, the researchers noted that “while NCQ results were scaled based on the current age of the respondent (up to age 50), Neuro-QoL scoring did not account for age, so the effect of current age on neurocognitive outcomes relative to the general population may be obscured.”

Results of the study also may be limited by the fact that it was conducted at a single center and had a lower response rate as well as a lack of racial and ethnic diversity.

Despite this, Dr. Wu said, “studies like ours can also help identify vulnerable populations at higher risk for post-HCT neurocognitive dysfunction.” 

Any conflicts of interest declared by the authors can be found in the original article.

Reference

Wu N, Phipps A, Krull K, et al. Long-term patient-reported neurocognitive outcomes in adult survivors of hematopoietic cell transplant [published online 2022 May 18]. Blood Adv. doi: 10.1182/bloodadvances.2021006672.

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