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).