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Long-term neurocognitive and quality of life outcomes in survivors of pediatric hematopoietic cell transplant

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Abstract

Purpose

Pediatric patients who undergo hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments, which can impact quality of life. Given limited long-term studies, we aimed to characterize the late neurocognitive outcomes in a cohort of pediatric HCT survivors.

Methods

Eligible survivors (HCT at age < 21 year and ≥ 1 year post-HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) and the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL). Analyses of risk factors included univariate comparisons and multivariable logistic regression.

Results

Participants (n = 199, 50.3% female, 53.3% acute leukemia, 87.9% allogeneic transplants) were surveyed at median age of 37.8 years (interquartile range [IQR] 28.5–48.8) at survey and median 27.6 years (IQR 17.0–34.0) from transplant. On the CCSS-NCQ, 18.9–32.5% of survivors reported impairments (Z score > 1.28) in task efficiency, memory, emotional regulation, or organization, compared with expected 10% in the general population (all p < 0.01). In contrast, survivors reported average Neuro-QoL (T score 49.6±0.7) compared with population normative value of 50 (p = 0.52). In multivariable regression, impaired Neuro-QoL (T score < 40) was independently associated with hearing issues (OR 4.97, 95% CI 1.96-12.6), history of stroke or seizure (OR 4.46, 95% CI 1.44-13.8), and sleep disturbances (OR 6.95, 95% CI 2.53–19.1).

Conclusions

Although long-term survivors of pediatric HCT reported higher rates of impairment in specific neurocognitive domains, cognitive quality of life was perceived as similar to the general population. Subsets of survivors with certain co-morbidities had substantially worse neurocognitive outcomes.

Implications for Cancer Survivors

While the long-term impact of pediatric HCT can include neurocognitive deficits, survivors report average cognitive quality of life.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Code availability

The code generated during the current study is available from the corresponding author on reasonable request.

Funding

This study was funded in part by the National Institute of Health (NIH) grants CA15704 and CA18029.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Hematology/Oncology, University of Washington, Seattle Children’s Hospital, 4600 Sand Point Way NE, Seattle, WA, 98105, USA

    Natalie L. Wu & Eric J. Chow

  2. Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109, USA

    Natalie L. Wu, Kara L. Cushing-Haugen, Stephanie J. Lee & Eric J. Chow

  3. Department of Epidemiology and Cancer Control, Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Kevin R. Krull

  4. Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Nicole J. Ullrich

  5. Department of Pediatrics, Yale University School of Medicine, Yale Cancer Center, PO Box 208028, New Haven, CT, 06520, USA

    Nina S. Kadan-Lottick

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  1. Natalie L. Wu
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Contributions

Kevin R. Krull, Nicole J. Ullrich, Nina S. Kadan-Lottick, Stephanie J. Lee, and Eric J. Chow contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Natalie L. Wu, Kara L. Cushing-Haugen, and Eric J. Chow. The first draft of the manuscript was written by Natalie L. Wu and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Natalie L. Wu.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Fred Hutchinson Institutional Review Board on March 16, 2018.

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Informed consent was obtained from all individual participants included in the study.

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Not applicable.

Conflict of interest

The authors declare no competing interests.

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Wu, N.L., Krull, K.R., Cushing-Haugen, K.L. et al. Long-term neurocognitive and quality of life outcomes in survivors of pediatric hematopoietic cell transplant. J Cancer Surviv 16, 696–704 (2022). https://doi.org/10.1007/s11764-021-01063-1

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  • DOI: https://doi.org/10.1007/s11764-021-01063-1

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