title: Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N., Seattle, WA 98109-1024, USA. ksyrjala@fhcrc.org
authors.forename: Karen L
authors.initials: KL
authors.lastname: Syrjala
authors.forename: Samantha B
authors.initials: SB
authors.lastname: Artherholt
authors.forename: Brenda F
authors.initials: BF
authors.lastname: Kurland
authors.forename: Shelby L
authors.initials: SL
authors.lastname: Langer
authors.forename: Sari
authors.initials: S
authors.lastname: Roth-Roemer
authors.forename: JoAnn Broeckel
authors.initials: JB
authors.lastname: Elrod
authors.forename: Sureyya
authors.initials: S
authors.lastname: Dikmen
mesh_terms: D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D011446:Prospective Studies; D017741:Survivors; D013997:Time Factors; D014184:Transplantation, Homologous