Mental Status Changes After Hematopoietic Stem Cell Transplantation
Mental Status Changes After Hematopoietic Stem Cell Transplantation
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DOI：
10.1002/cncr.24496
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发表时间：
2009-10-01
期刊：
影响因子：
6.2
通讯作者：
Antin, Joseph H.
中科院分区：
文献类型：
--
作者：
Chang, Grace;Meadows, Mary-Ellen;Antin, Joseph H.
背景：越来越多的创新癌症治疗（例如造血干细胞移植（HSCT））的幸存者经常报告随后的认知困难。本研究的目的是评估和比较慢性粒细胞白血病 (CIVIL) 或原发性骨髓增生异常综合征 (MDS) 患者在异基因 HSCT 或其他治疗后的神经认知变化。方法：在这项前瞻性队列研究中，对 106 名符合条件的患者进行连续样本评估，这些患者在入组时以及 HSCT 或其他治疗后 12 个月和 18 个月患有 CIVIL (n = 91) 或 MDS (n = 15)。结果：入组时、12 个月和 18 个月时的 3 次评估分别由 98%、95% 和 89% 的存活参与者完成。所有患者的记忆力在 18 个月内都有显着改善。例如，接受 HSCT 的 45 名患者（42 名 CIVIL 患者和 3 名 MDS 患者）在大多数神经心理功能指标上与接受其他治疗的患者相比，除了心理健康状况有所改善（P = .034）、身体功能较差（P = .049）以及双侧协调和精细运动速度更困难（优势手，P = .005；非优势手，P = .0019）之外。 CIVIL 患者的音素流畅度总体有所提高 (P =.014)。结论：当前的研究表明，时间和诊断可能是评估神经认知和其他变化时的重要因素，HSCT 后有关“化疗脑”的抱怨值得进一步研究，因为缺陷实际上可能早于治疗开始，随后可能会改善。该研究结果可以让潜在的 HSCT 接受者放心，因为当考虑到精神状态副作用时，HSCT 与其他治疗相比具有优势。癌症 2009；115：4625-35。 (C) 2009 年美国癌症协会。
BACKGROUND: The growing numbers of survivors of innovative cancer treatments, such as hematopoietic stem cell transplantation (HSCT), often report subsequent cognitive difficulties. The objective of this study was to evaluate and compare neurocognitive changes in patients with chronic myelogenous leukemia (CIVIL) or primary myelodysplastic syndrome (MDS) after allogeneic HSCT or other therapies. METHODS: In this prospective cohort study, serial evaluations of attention, concentration, memory, mood, and quality of life were used in a consecutive sample of 106 eligible patients who had CIVIL (n = 91) or MDS (n = 15) at enrollment and then 12 months and 18 months after HSCT or other therapy. RESULTS: The 3 evaluations at enrollment, 12 months, and 18 months were completed by 98%, 95%, and 89% of surviving participants, respectively. Among all patients, there was significant improvement in memory over 18 months. For example, the 45 patients who underwent HSCT (42 patients with CIVIL and 3 patients with MDS) compared favorably with the patients who received other treatment on most measures of neuropsychological function, except they had improved mental health (P =.034), worse physical function (P =.049), and more difficulty with coordination and fine motor speed bilaterally (dominant hand, P =.005; nondominant hand, P =.0019). Patients with CIVIL overall had improved phonemic fluency (P =.014). CONCLUSIONS: The current study indicated that time and diagnosis may be important factors when assessing neurocognitive and other changes, Complaints regarding "chemobrain" after HSCT merit further study, because deficits actually may predate the initiation of treatment and subsequently may improve. The study results could reassure prospective HSCT recipients, because HSCT compared favorably with other treatments when mental status side effects were considered. Cancer 2009;115:4625-35. (C) 2009 American Cancer Society.