Associations of Baseline Cognitive and Psychosocial Function With Clinical Outcomes After Autologous Stem Cell Transplantation in a Multiple Myeloma Sample

Background

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Objectives

Autologous stem cell transplantation (ASCT) remains a standard frontline treatment for eligible patients with multiple myeloma and is associated with im-proved progression-free survival and sustained treatment responses. In addition to medi-cal eligibility factors, pre-treatment psychosocial variables such as depression and anxiety as well as cognitive functioning may influence short and long-term transplant outcomes. This study examined the relationship between pre-transplant psychosocial and cognitive functioning and clinical outcomes in patients with multiple myeloma undergoing ASCT.

Methods

Participants (N = 245) undergoing ASCT in Miami, Florida completed routine pre-transplant psychosocial and neuropsychological assessments. Patient-reported clini-cal variables and cognitive performance were examined in relation to transplant success and transplant recovery outcomes, including time to engraftment, length of hospital stay post-engraftment, and survival across four timepoints.

Results

While most patients achieved engraftment within a similar timeframe, the duration of hospitalization follow-ing engraftment varied considerably. Higher baseline trait anxiety was associated with longer post-engraftment hospital stays. In multivariable Cox regression analyses, post-engraftment length of stay was independently associated with long-term mortality when modeled as a continuous variable. In a secondary analysis using an empirically de-rived cutoff corresponding to stays longer than the 80th percentile (≥7 days post-engraftment), both prolonged post-engraftment hospitalization and poorer baseline delayed memory were independently associated with mortality. Descriptive survival analyses further showed that patients with prolonged post-engraftment hospitalizations had higher overall mortality and shorter survival than those with shorter post-engraftment hospital stays.

Conclusions

Patients who demonstrated delayed memory performance pre-transplant and prolonged hospital admission post-transplant may be most vulnerable to dying when examined at long-term follow-up. Pre-transplant psychiatric assessments provide an opportunity to identify potentially implement supportive care interventions for patients at increased vulnerability for cognitive impairment.