An international panel of experts has issued a report on neurocognitive dysfunction after hematopoietic cell transplantation (HCT) to help clinicians understand the scope of this health-related problem, highlight its impact on the well-being of survivors, and help determine factors that may improve identification of patients at risk for declines in cognitive functioning after HCT.
The expert panel was a collaboration between the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research® (CIBMTR®) and the Complications and Quality of Life Working Party of the European Society for Blood and Marrow Transplantation (EBMT).
The CIBMTR/EBMT panel developed 4 potential strategies to mitigate the risks or improve outcomes of neurocognitive dysfunction after HCT:
- Interventions to minimize therapy-related neurocognitive toxicity
- Management of acute CNS toxicities after allogeneic HCT
- Non-pharmacologic interventions
- Pharmacologic interventions
Clinical strategies discussed in the assessment to minimize therapy-related neurocognitive toxicity include reducing the use of neurotoxic therapies such as prophylactic cranial radiation, total body irradiation (TBI), or neurotoxic agents, and the substitution of busulfan for TBI-based conditioning during treatment.
Examples of potential pharmacologic interventions recommended by the panel include using:
- methylphenidate
- donepezil
- modafinil
- recombinant human growth hormone when indicated
These drugs have shown efficacy in improving attention, concentration, executive function, and memory in adult and young adult survivors of other cancers.
The panel reviewed emerging neurologic-specific biomarkers of central nervous system injury and neuroinflammation, and urged clinicians to use these tools in combination with neuroimaging to evaluate neurocognitive dysfunction after HCT.
The panel concluded that “the combination of a wider application of neurocognitive assessments with newly developed biomarkers may prove to be a powerful combination of tools used to define at-risk HCT recipients.”
Kelly DL, et al. Biol Blood Marrow Transplant