loading page

Long-term Neurocognitive and Quality of Life Outcomes in Survivors of Pediatric Hematopoietic Cell Transplant
  • +4
  • Natalie Wu,
  • Kevin Krull,
  • Kara Cushing-Haugen,
  • Nicole Ullrich,
  • Nina Kadan-Lottick,
  • Stephanie Lee,
  • Eric Chow
Natalie Wu
Seattle Children's Hospital

Corresponding Author:[email protected]

Author Profile
Kevin Krull
St Jude Children's Research Hospital
Author Profile
Kara Cushing-Haugen
Fred Hutchinson Cancer Research Center
Author Profile
Nicole Ullrich
Children's Hospital Boston
Author Profile
Nina Kadan-Lottick
Yale University School of Medicine
Author Profile
Stephanie Lee
Fred Hutchinson Cancer Research Center
Author Profile
Eric Chow
Fred Hutchinson Cancer Research Center
Author Profile


Background: Pediatric patients who undergo hematopoietic cell transplant (HCT) are at risk for neurocognitive impairments; however, long-term studies are lacking. Procedure: Eligible survivors (HCT at age <21y and ≥1y post-HCT) completed a 60-question survey of neurocognitive function and quality of life, which included the Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS-NCQ) and the Neuro-Quality of Life Cognitive Function Short Form (Neuro-QoL). Baseline demographic and transplant characteristics were retrieved from the institutional research database. Analyses of risk factors included univariate comparisons and multivariable logistic regression. Results: Participants (n=199, 50.3% female, 53.3% acute leukemia, 87.9% allogeneic transplants) were surveyed at median age of 37.8 years (range 18-61) at survey and median 27.6 years (range 1-46) from transplant. On the CCSS-NCQ, 18.9-32.5% of survivors reported impairments (Z-score >1.28) in task efficiency, memory, emotional regulation, or organization, compared with expected 10% in the general population (all p<0.01). Certain co-morbidities were associated with impaired CCSS-NCQ scores. However, survivors reported average Neuro-QoL (T-score 49.6±0.7) compared with population normative value of 50 (p=0.52). In multivariable regression, impaired Neuro-QoL (T-score <40) was independently associated with hearing issues (OR 4.79, 95% CI 1.91-12.0), history of stroke or seizure (OR 5.22, 95% CI 1.73-15.7), and sleep disturbances (OR 6.90, 95% CI 2.53-18.9). Conclusions: Although long-term survivors of pediatric HCT reported higher rates of impairment in specific neurocognitive domains, cognitive quality of life was perceived as similar to the general population. Subsets of survivors with certain co-morbidities had substantially worse neurocognitive outcomes.