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Psychosocial Studies

Rehabilitation of therapy-related cognitive deficits in patients after hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 41, pages 79–90 (2008)Cite this article

Abstract

Neuropsychological deficits are potential side effects of hematopoietic stem cell therapy (HSCT). Systematic data on the long-term course of and therapeutic options for these consequences are limited. One hundred fifty-seven patients were screened for cognitive deficits following HSCT for malignant diseases at an in-patient oncologic rehabilitation clinic. Patients showing evidence of impairment were randomly assigned to one of two training groups: individualized PC-supported training or neuropsychological group therapy. The control group consisted of patients who received no specific training. During in-patient rehabilitation, the results of a comprehensive neuropsychological test battery improved significantly in all three groups, and no specific intervention effects were identified. Neuropsychological deficits were still evident in a subgroup of patients 6 months later. Correlation between neuropsychological testing and patients' self-evaluation of cognitive functioning in daily life was generally low. Sustained attention and verbal-semantic memory played the main role for self-appraisal and in the designation as ‘neuropsychologically impaired’. In conclusion, a substantial number of patients revealed evidence of cognitive deficits a long time after HSCT. There is a need for more studies and for the development of differentiated rehabilitative measures for such therapeutic consequences.

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References

  1. Keime-Guibert F, Napolitano M, Delattre JY . Neurological complications of radiotherapy and chemotherapy. J Neurol 1998; 245: 695–708.

    Article  CAS  PubMed  Google Scholar 

  2. Shah AK . Cyclosporine A neurotoxicity among bone marrow transplant recipients. Clin Neuropharmacol 1999; 2: 67–73.

    Article  Google Scholar 

  3. Tuxen MK, Hansen SW . Neurotoxicity secondary to antineoplastic drugs. Cancer Treat Rev 1994; 20: 191–214.

    Article  CAS  PubMed  Google Scholar 

  4. Verstappen CCP, Heimans JJ, Hoekman K, Postma TJ . Neurotoxic complications of chemotherapy in patients with cancer. Drugs 2003; 63: 1549–1563.

    Article  CAS  PubMed  Google Scholar 

  5. Butler RW, Copeland DR . Neuropsychological effects of central nervous system prophylactic treatment in childhood leukemia: methodological considerations. J Pediat Psychol 1993; 18: 319–338.

    Article  CAS  Google Scholar 

  6. Mulhern RK, Merchant TE, Gajjar A, Reddick WE, Kun LE . Late neurocognitive sequelae in survivors of brain tumors in childhood. Lancet Oncol 2004; 5: 399–408.

    Article  PubMed  Google Scholar 

  7. Waber DP, Tarbell NJ, Kahn CM, Gelber RD, Sallan SE . The relationship of sex and treatment modality to neuropsychologic outcome in childhood acute lymphoblastic leukemia. J Clin Oncol 1992; 10: 810–817.

    Article  CAS  PubMed  Google Scholar 

  8. Shusterman S, Meadows AT . Long term survivors of childhood leukemia. Curr Opin Hematol 2000; 7: 217–222.

    Article  CAS  PubMed  Google Scholar 

  9. Arvidson J, Kihlgren M, Hall C, Lönnerholm G . Neuropsychological functioning after treatment for hematological malignancies in childhood, including autologous bone marrow transplantation. Ped Hematol Oncol 1999; 16: 9–21.

    Article  CAS  Google Scholar 

  10. Butler RW, Copeland DR . Attentional processes and their remediation in children treated for cancer: a literature review and the development of a therapeutic approach. J Int Neuropsychol Soc 2002; 8: 115–124.

    Article  PubMed  Google Scholar 

  11. Iuvone L, Mariotti P, Colosimo C, Guzzetta F, Ruggiero A, Riccardi R . Long-term cognitive outcome, brain computed tomography scan, and magnetic resonance imaging in children cured for acute lymphoblastic leukemia. Cancer 2002; 95: 2562–2570.

    Article  PubMed  Google Scholar 

  12. Van Dongen-Melman JEWM, De Groot A, Van Dongen JJM, Verhulst FC, Hählen K . Cranial irradiation is the major cause of learning problems in children treated for leukemia and lymphoma: a comparative study. Leukemia 1997; 11: 1197–1200.

    Article  CAS  PubMed  Google Scholar 

  13. Kaleita TA, Reaman GH, MacLean WE, Sather HN, Whitt JK . Neurodevelopmental outcome of infants with acute lymphoblastic leukemia: a Children's Cancer Group report. Cancer 1999; 85: 1859–1865.

    Article  CAS  PubMed  Google Scholar 

  14. Leahy AM, Teunissen H, Friedman DL, Moshang T, Lange BJ, Meadows AT . Late effects of chemotherapy compared to bone marrow trasnplantation in the treatment of pediatric acute myeloid leukemia and myelodysplasia. Med Pediatr Oncol 1999; 17: 167–171.

    Google Scholar 

  15. Reddy AT, Witek K . Neurologic complications of chemotherapy for children with cancer. Curr Neurol Neurosc Rep 2003; 3: 137–142.

    Article  Google Scholar 

  16. Jenney MEM, Levitt GA . The quality of survival after childhood cancer. Eur J Cancer 2002; 38: 1241–1250.

    Article  CAS  PubMed  Google Scholar 

  17. Brouwers P, Poplack D . Memory and learning sequelae in long-term survivors of acute lymphoblastic leukemia: association with attention deficits. Am J Pediatr Hematol Oncol 1990; 12: 174–181.

    Article  CAS  PubMed  Google Scholar 

  18. Rodgers J, Horrocks J, Britton PG, Kernahan J . Attentional ability among survivors of leukemia. Arch Dis Child 1999; 80: 318–323.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Mirsky A, Anthony B, Duncan C, Ahearn M, Kellan S . Analysis of elements of attention: a neuropsychological approach. Neuropsychol Rev 1991; 2: 109–145.

    Article  CAS  PubMed  Google Scholar 

  20. Aaronson NK, Meyerowitz BE, Bard M, Bloom JR, Fawzy FI, Feldstein M et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a qualitiy-of-life instrument for use in international clinical trials in oncology. J Nat Cancer Inst 1993; 85: 365–376.

    Article  CAS  PubMed  Google Scholar 

  21. Smets EMA, Garssen B, Bonke B, De Haes JCJM . The Multidimensional Fatigue Inventory (MFI): psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995; 39: 315–325.

    Article  CAS  PubMed  Google Scholar 

  22. Herrmann CH, Buss U, Snaith RP . Hospital Anxiety and Depression Scale—Deutsche Version (HADS-D). Huber: Bern, Switzerland, 1995.

    Google Scholar 

  23. Zimmermann P, Messner C, Poser U, Sedelmaier P . Ein Fragebogen erlebter Defizite der Aufmerksamkeit (Questionnaire of Self-Perceived Deficits in Attention: FEDA) Unpublished manuscript. University of Freiburg: Germany, 1991.

    Google Scholar 

  24. Zimmermann P, Fimm B . Testbatterie zur Aufmerksamkeitsprüfung (Test Battery for Attentional Performance: TAP; Version 1.7). Psytest: Würselen, Germany, 2001.

    Google Scholar 

  25. Wilson BA, Cockburn J, Baddeley AD . Rivermead Behavioral Memory Test. Thames Valley Test Company: Bury St Edmunds, 1985 (German adaption: Beckers K, Behrends U, Canavan A. Neurologisches Therapie Centrum: Düsseldorf, Germany 1992).

    Google Scholar 

  26. Wechsler D . Wechsler Memory Scale—Revised Form (WMS-R). The Psychological Corporation: San Antonio, 1987 (German adaption: Härting C, Markowitsch HJ, Neufeld H, Calabrese P, Deisinger K, Kessler J. Huber: Bern, Switzerland, 2000).

    Google Scholar 

  27. Bäumler G . Der Lern- und Gedächtnistest LGT-3 (Learning and Memory Test). Hogrefe: Göttingen, Germany, 1974.

    Google Scholar 

  28. Bernabeu Verdu J, Lopez Luengo B, Fournier de Castillo C, Canete Nieto A, Suarez Rodriguez J, Castel Sanchez V . Attention process training application within an intervention project on attentional processes in children with cancer. Revista Neurol 2004; 38: 482–486.

    CAS  Google Scholar 

  29. Butler RW, Mulhern RK . Neurocognitive interventions for children and adolescents surviving cancer. J Pediatr Psychol 2005; 30: 65–78.

    Article  PubMed  Google Scholar 

  30. Andrykowski MA, Henslee PJ, Farral MG . Physical and psychosocial functioning of adult survivors of allogeneic bone marrow transplantation. Bone Marrow Transplant 1989; 4: 75–81.

    CAS  PubMed  Google Scholar 

  31. Syrjala KL, Chapko MK, Vitaliano PP, Cummings C, Sullivan KM . Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplant 1993; 11: 319–327.

    CAS  PubMed  Google Scholar 

  32. Parth P, Dunlap WP, Kennedy RS, Lane NE, Ordy JM . Motor and cognitive testing of bone marrow transplant patients after chemoradiotherapy. Percept Mot Skills 1989; 68: 1227–1241.

    Article  CAS  PubMed  Google Scholar 

  33. Meyers CA, Weitzner M, Byrne K, Valentine A, Champlin RE, Przepiorka D . Evaluation of the neurobehavioral functioning of patients before, during, and after bone marrow transplantation. J Clin Oncol 1994; 12: 820–826.

    Article  CAS  PubMed  Google Scholar 

  34. Andrykowski MA, Schmitt FA, Gregg ME, Brady MJ, Lamb DG, Henslee-Downey PJ . Neuropsychologic impairment in adult bone marrow transplant candidates. Cancer 1992; 70: 2288–2297.

    Article  CAS  PubMed  Google Scholar 

  35. Harder H, Cornelissen JJ, Van Gool AR, Duivenvoorden HJ, Eijkenboom WMH, van den Bent MJ . Cognitive functioning and quality of life in long-term adult survivors of bone marrow transplantation. Cancer 2002; 95: 183–192.

    Article  PubMed  Google Scholar 

  36. Sostak P, Padovan CS, Yousry TA, Ledderose G, Kolb HJ, Straube A . Prospective evaluation of neurological complications after allogeneic bone marrow transplantation. Neurology 2003; 60: 842–848.

    Article  CAS  PubMed  Google Scholar 

  37. Ylikoski R, Ylikoski A, Erkinjuntti T, Sulkava R, Raininko R, Tilvis R . White matter changes in healthy elderly persons correlate with attention and speed of mental processing. Arch Neurol 1993; 50: 818–824.

    Article  CAS  PubMed  Google Scholar 

  38. Syrjala KL, Dikmen SS, Langer S, Roth-Roemer S, Abrams J . Neuropsychological changes from pretransplant to one year in patients receiving myeloablative allogeneic hematopoietic cell transplant. Blood 2004; 104: 3386–3392.

    Article  CAS  PubMed  Google Scholar 

  39. Booth-Jones M, Jacobsen PB, Ransom S, Soety E . Characteristics and correlates of cognitive functioning following bone marrow transplantation. Bone Marrow Transplant 2005; 36: 695–702.

    Article  CAS  PubMed  Google Scholar 

  40. Lezak MD, Howieson DB, Loring DW . Neuropsychological assessment, 4th edn. Oxford University Press: New York, NY, 2004.

    Google Scholar 

  41. Meyers CA . Neurocognitive dysfunction in cancer patients. Oncology 2000; 14: 75–79.

    CAS  PubMed  Google Scholar 

  42. Tannock IF, Ahles TA, Ganz PA, van Dam FS . Cognitive impairment associated with chemotherapy for cancer: report of a workshop. J Clin Oncol 2004; 22: 2233–2239.

    Article  PubMed  Google Scholar 

  43. Meier RJ, Benton AL, Diller L (eds). Neuropsychological Rehabilitation. Churchill Livingstone: Edinburgh, 1987.

    Google Scholar 

  44. Sohlberg MM, Mateer CA . Introduction to cognitive rehabilitation. Theory and practice. Guilford Press: New York, NY, 1989.

    Google Scholar 

  45. Bartsch HH, Weis J, Mumm A . Stationäre Rehabilitation und ambulante Nachsorge bei allogener Stammzelltransplantation. Unpublished study report. Tumor Biology Center: Freiburg, Germany, 2006.

    Google Scholar 

  46. Weis J, Bartsch HH, Nagel GA, Unger C . Psychosocial care for cancer patients: a new holistic psychosomatic approach in acute care and rehabilitation. Psycho-Oncology 1996; 5: 51–54.

    Article  Google Scholar 

  47. Poppelreuter M, Weis J, Külz AK, Tucha O, Lange KW, Bartsch HH . Cognitive dysfunction and subjective complaints of cancer patients: a cross-sectional study in a cancer rehabilitation center. Eur J Cancer 2004; 40: 43–49.

    Article  CAS  PubMed  Google Scholar 

  48. Sturm W, Willmes K, Orgass B, Hartje W . Do specific attention deficits need specific training? Neuropsychol Rehab 1997; 7: 81–103.

    Article  Google Scholar 

  49. Sturm W . Evaluation in therapeutical contexts: attentional and neglect disorders. Eur Rev Appl Psychol 1996; 46: 207–215.

    Google Scholar 

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Acknowledgements

This study was supported by the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF, Berlin, Germany, Grant number 02821) and the German Pension Fund (Deutsche Rentenversicherung-Bund, Berlin, Germany).

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Authors and Affiliations

  1. Institute for Rehabilitation Research, Tumor Biology Center, Freiburg, Germany

    M Poppelreuter, J Weis, A Mumm & H H Bartsch

  2. Klinik Bavaria, Kreischa, Germany

    H B Orth

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  1. M Poppelreuter
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  2. J Weis
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  3. A Mumm
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  4. H B Orth
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  5. H H Bartsch
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Correspondence to M Poppelreuter.

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Poppelreuter, M., Weis, J., Mumm, A. et al. Rehabilitation of therapy-related cognitive deficits in patients after hematopoietic stem cell transplantation. Bone Marrow Transplant 41, 79–90 (2008). https://doi.org/10.1038/sj.bmt.1705884

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