Expert review of hematology · 2025
Cognitive impairment in hematology patients planned for chimeric antigen receptor T-cell therapy.
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Kuznetsova Valeriya, Rosenfeld Hannah, Sales Carmela, van der Linde Sam, Roos Izanne, Roberts Stefanie, D'Aprano Fiore, Loi Samantha M, Dowling Mark, Dickinson Michael, Kalincik Tomas, Harrison Simon J, Malpas Charles B, Anderson Mary Ann
Аннотация
BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy is used to treat several types of relapsed and refractory hematological malignancies and is associated with cognitive side-effects. The accurate diagnosis of cognitive impairment following CAR-T requires knowledge of baseline cognitive status prior to the therapy.
RESEARCH DESIGN AND METHODS: Adult patients with advanced hematologic or solid organ malignancies underwent cognitive assessment, including a self-report questionnaire of psychopathology and subjective cognitive function, prior to receiving CAR-T. A subset of individuals also completed the Montreal Cognitive Assessment (MoCA) to examine utility of cognitive screening.
RESULTS: Of 60 patients included, 16 (27%) had cognitive impairment, with six unique patterns of dysfunction. Memory impairment was the most common finding (15%). Impaired patients were more likely to have B-cell acute lymphoblastic leukemia (p = 0.024, BF10 = 9.30), be younger (p = 0.007, BF10 = 7.76), have bone marrow involvement (p = 0.037, BF10 = 5.18), or have evidence of psychopathology (p = 0.004, BF10 = 31.30). Analyses did not support the utility of cognitive screening. Of those patients who completed a self-report measure of psychopathology, nine (16%) were elevated on at least one symptom domain.
CONCLUSIONS: The findings demonstrate a broad spectrum of cognitive and psychological symptoms, emphasizing the importance of baseline evaluation for detecting cognitive symptoms that might arise after CAR-T.
RESEARCH DESIGN AND METHODS: Adult patients with advanced hematologic or solid organ malignancies underwent cognitive assessment, including a self-report questionnaire of psychopathology and subjective cognitive function, prior to receiving CAR-T. A subset of individuals also completed the Montreal Cognitive Assessment (MoCA) to examine utility of cognitive screening.
RESULTS: Of 60 patients included, 16 (27%) had cognitive impairment, with six unique patterns of dysfunction. Memory impairment was the most common finding (15%). Impaired patients were more likely to have B-cell acute lymphoblastic leukemia (p = 0.024, BF10 = 9.30), be younger (p = 0.007, BF10 = 7.76), have bone marrow involvement (p = 0.037, BF10 = 5.18), or have evidence of psychopathology (p = 0.004, BF10 = 31.30). Analyses did not support the utility of cognitive screening. Of those patients who completed a self-report measure of psychopathology, nine (16%) were elevated on at least one symptom domain.
CONCLUSIONS: The findings demonstrate a broad spectrum of cognitive and psychological symptoms, emphasizing the importance of baseline evaluation for detecting cognitive symptoms that might arise after CAR-T.