HCT and Neurocognitive Dysfunction: Recognizing Risk Factors and Developing Treatments

Neurocognitive dysfunction, including symptoms such as memory impairment, decreased concentration, and difficulty in performing multiple tasks simultaneously, can significantly affect hematopoietic cell transplantation (HCT) patients’ quality of life, and is a major cause of post-transplant morbidity and mortality.

Research has demonstrated that neurocognitive dysfunction is associated with risk factors such as pre-transplant chemotherapy, use of total body irradiation, immunosuppressive therapies, length of hospital stay, and graft-versus-host disease (GVHD).

Awareness of the risk factors and likelihood of neurocognitive dysfunction after HCT is important for counseling patients pre-transplant, and may also lead to earlier identification of emerging toxicities that can guide referrals to appropriate specialists.

The authors outline both pharmacologic and non-pharmacologic interventions to minimize therapy-related neurocognitive toxicity and manage acute central nervous system (CNS) toxicities after allogeneic HCT. These strategies include:

  • Using biomarkers of CNS injury and neuroinflammation to guide treatment
  • Avoiding prophylactic cranial irradiation
  • Administering methylphenidate, donepezil, modafinil, and/or recombinant human growth hormone
  • Aggressively managing thrombotic microangiopathy (TMA) and posterior reversible encephalopathy (PRES)
  • Employing cognitive remedial approaches, including cognitive behavioral therapy and social skills training

The recommendations in the review were jointly developed by working committees of the CIBMTR® (Center for International Blood and Marrow Transplant Research®) and the European Society for Blood and Marrow Transplantation (EBMT).

Buchbinder D, et al. Bone Marrow Transplant