BACKGROUND Studies suggest that patients with cancer who undergo hematopoietic cell transplantation (HCT) are at risk for cognitive deficits. To date, little research has investigated the cumulative effects of clinical risk factors on cognitive function in patients who undergo HCT. METHODS Patients (N = 278) who were scheduled to undergo HCT for hematologic disease completed neuropsychological assessments before HCT and at 6 months and 12 months after HCT. A time-varying cumulative clinical risk variable was examined as a predictor of total neuropsychological performance (TNP). Cumulative clinical risk was calculated from pre-HCT neuropsychological risk factors (eg, history of cranial irradiation, intrathecal chemotherapy), HCT-related risk factors (eg, allogeneic transplantation, unrelated donor), and post-HCT complications (eg, severity of mucositis and enteritis, graft-versus-host disease). RESULTS Patients with greater cumulative clinical risk displayed worse TNP at baseline and at 6 months after HCT and less neuropsychological recovery over time than patients who had less risk (Ps < .05). Greater cumulative clinical risk predicted worse performance on tasks assessing executive function at baseline and 6 months after HCT and assessing memory at 6 months and 12 months after HCT (Ps < .05). Among risk variables, length of hospital stay was the only significant predictor of neuropsychological function (P < .05). CONCLUSIONS Findings from this study indicated that clinical risk factors may have a cumulative effect on cognitive function in patients who undergo HCT. Patients who have a complicated clinical course should be referred for evaluation and management of cognitive deficits.
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