Cancer-related Cognitive Impairment Found in Older Adults with Acute Myeloid Leukemia Treated With Combination Therapy

Older patients with acute myeloid leukemia (AML) who received hypomethylating agents and venetoclax chemotherapy (HMA + Ven) reported objective and subjective cognitive decline at different treatment timepoints, according to research presented at the 48th Oncology Nursing Society (ONS) Congress in San Antonio, Texas.

Cancer-related cognitive impairment (CRCI) has been found among those diagnosed with most cancers. Those with CRCI often have trouble working, maintaining social connection, and/or performing daily activities. One of the gaps in our knowledge is understanding whether CRCI affects older adults with AML.

A prospective, longitudinal study was used to determine whether CRCI affects older adults (≥ 60 years) with AML who received HMA + Ven. The researchers assessed study participants at specific timepoints of their cancer treatment: cycle 1 (n = 14), cycle 2 (n = 11), and cycle 2 to cycle 4 (n = 4). The mean age of sample was 73.6 ± 8 (64-89) years. The reason for attrition, according to the researchers, was either a change of treatment (n = 4), death (n = 2), or delayed treatment (n = 1).

Further, the researchers assessed subjective cognitive function using the Functional Assessment of Impairment of Cancer Therapy-Cognitive Function and objective cognitive function using several different neuropsychological measures, including the Hopkins Verbal Learning Test-Revised (HVLT-R), Digit Span (DS)-forward and backward tests, Delis-Kaplan Executive Function System Letter Fluency Test, and the Trail Making Test.

“We conducted descriptive analysis to assess the minimal clinically important differences and practice effects adjusted reliable change index to determine individual change of cognitive function; cut-off score and the International Cancer and Cognition Task Force z-score criteria to calculate prevalence of cognitive impairment,” the researchers wrote.

The researchers found that more than a quarter of the study participants (27%) reported a decline in cognitive function from cycle 1 to cycle 2, while none experienced a subjective decline from cycle 2 to cycle 4. Declines in neuropsychological measures, specifically the HVLT-R, DS forward and backward tests, were observed at different timepoints, from cycle 1 to cycle 2 and from cycle 2 to cycle 4. Additionally, the highest percentage of subjective cognitive impairment took place at cycle 2 (63%). Specifically, HVLT-R delayed recall had the highest prevalence of impairment across all cycles.

It was noted that the small sample size of the study is a major limitation, and the percentages should be viewed conservatively. Still, the researchers believe that the results of the current study will help guide future longitudinal studies with a larger and more diverse study population.

Reference

Chan Y-N, Piepmeier A, Hirschey R, Bender C, Zou B, Brant AL. Is there cancer-related cognitive impairment in older adults with acute myeloid leukemia treated with hypomethylating agents and venetoclax chemotherapy. Poster presented at: 48th ONS Congress Meeting; April 26 – 30, 2023; San Antonio, TX. Accessed April 17, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12604.