Predictors of change in cognitive function for patients with cancer treated with allogeneic hematopoietic cell transplant

BACKGROUND: Many patients experience cognitive decline after hematopoietic stem cell transplant (HCT). This retrospective analysis evaluated trajectories of cognitive function in HCT patients. The study purpose was to identify the most common predictors of post-HCT cognitive change and inform earlier identification and pursuit of interventions to improve the impact on healthcare compliance, quality of life, and survivorship. MATERIALS & METHODS: Duke Adult Bone Marrow Transplant clinic Clinical Pre-, Peri, and Post-HCT Optimization Program (C-POP) assessments data collected between 2018 and 2023 were analyzed (n = 282). Cognitive function was measured with the Montreal Cognitive Assessment (MoCA). RESULTS: Fifty-six (19.9%) participants' MoCA scores were <26 (mild cognitive impairment cutpoint) at pre-treatment sign-off (SO). Pre/post-HCT comparisons from SO to year-1 (Y1) (n = 103) indicated 57 (55.3%) unchanged scores. At Y1, 15 participants' scores (14.56%) decreased ≥2 points, 31 (30.1%) improved ≥2 points, and only eighteen (17.4%) scored <26. Predictors for decreased scores included older age, female sex, decreased grip strength and frailty at Y1. Scores decreased for the cognitive domains of abstraction, delayed recall, and orientation. Changes were significant across timepoints. Those aged 40-59 showed the most decline for delayed recall and orientation. CONCLUSIONS: Prospective assessment of grip strength, frailty, and cognitive function (MoCA) may inform tailored interventions and rehabilitation interventions. Future research to investigate prehabilitation to maximize nutritional, cognitive, and fitness status is warranted.