Mental status changes precede hematopoietic stem cell transplantation

NEW YORK (Reuters Health) - Most mental status deficits in patients with chronic myelogenous leukemia (CML) or primary myelodysplastic syndrome (MDS) precede hematopoietic stem cell transplantation (HSCT) and may improve thereafter, according to research published in the October 1st Cancer.

"I was in fact surprised by the findings in that the overall performance on mental status test evaluations was worse at the inception of the study," Dr. Grace Chang from Harvard Medical School, Boston, told Reuters Health by email.

In 91 patients with CML and 15 with MDS, Dr. Chang and colleagues evaluated and compared the neurocognitive changes before HSCT and then 12 and 18 months later.

Generally, when significant time effects were identified, they were in the direction of improvement relative to baseline, the authors report.

Total recall and long-term memory storage showed significant gains from pre-HSCT to the 12-month and 18-month evaluations, with CML participants showing better performance than MDS participants on several neurocognitive measures.

HSCT recipients had low initial Mental Component Scale scores on the SF-36, but they showed significant gains at the 12- and 18-month evaluations.

Physical Component Scale scores were also lower among HSCT recipients at baseline. However, these deficits persisted through follow-up, although they were not attributed to HSCT.

The results from the Profile of Mood States did not differ by disease or treatment, the investigators report.

"Complaints regarding 'chemobrain' after HSCT merit further study, because deficits appear to predate the initiation of that treatment and subsequently improve," they conclude.

"'Chemobrain' is complex and not generalizable across diseases and treatments," Dr. Chang added. "Time and diagnosis are important to consider as mental status changes are reported."

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