KEY TAKEAWAYS
- The study assessed cancer-related cognitive impairment in elderly AML patients receiving hypomethylating agents and venetoclax chemotherapy.
- The study showed that older AML patients exhibited CRCI in verbal learning but not lexical fluency or executive function across four HMA+VEN cycles.
Cancer-related cognitive impairment (CRCI) has been documented among individuals who have survived various types of cancer. Those affected by CRCI often exhibit cognitive deficits spanning multiple domains, hindering their ability to work, maintain social connections, and carry out daily tasks. Despite this, the knowledge regarding CRCI in older adults diagnosed with acute myeloid leukemia (AML) remains limited. This study investigated CRCI in older adults aged 60 and above who have received hypomethylating agents and venetoclax (HMA+VEN) chemotherapy across multiple cycles, specifically cycles 1, 2, and 4.
To achieve this, researchers conducted a prospective longitudinal study, conducting assessments within three days of initiating cycles 1, 2, and 4 of HMA+VEN treatment. Researchers evaluated subjective cognitive function using the Functional Assessment of Impairment of Cancer Therapy-Cognitive Function. Additionally, objective cognitive function was assessed using a battery of neuropsychological tests, including the Hopkins Verbal Learning Test-Revised (HVLT-R), Digit Span (DS) – both forward and backward, Delis-Kaplan Executive Function System Letter Fluency Test, and the Trail Making Test. A descriptive analysis was employed to determine minimal clinically important differences, and practice effects adjusted reliable change index and individual changes in cognitive function. Cut-off scores and the International Cancer and Cognition Task Force z-score criteria were also used to calculate the prevalence of cognitive impairment.
In total, 14 participants completed assessments in cycle 1, 11 in cycle 2, and 4 in cycle 3. Attrition in participant numbers was due to treatment changes, death, and treatment delays. The average age of the sample was 73.6 years, with the majority being male (78.6%), non-Hispanic White (92.9%), and high school graduates (64.3%). Between cycles 1 and 2, up to 27% of participants reported subjective cognitive decline, but none experienced such a decline between cycles 2 and 4. Cognitive decline in the HVLT-R and DS-backward tests was observed in 10-40% of participants between cycles 1 and 2 and cycles 2 and 4. Across cycles 1, 2, and 4, participants experienced a prevalence of subjective or objective cognitive impairment ranging from 33% to 63%. Notably, HVLT-R delayed recall exhibited the highest impairment prevalence, ranging from 25% to 50%, across all cycles.
Older individuals diagnosed with AML exhibited either objective or subjective CRCI over four HMA+VEN treatment cycles, primarily affecting their verbal learning skills rather than lexical fluency or executive function. Caution should be exercised in interpreting these results due to the limited sample size. This study still contributed to the comprehension of CRCI in AML and provides direction for future long-term investigations.
Source: https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12604
Clinical Trial: https://classic.clinicaltrials.gov/ct2/show/NCT04644419
Chan, Y-N., Piepmeier, A., Hirschey, R., Bender, C., Zou, B., Bryant, A.L. Is There Cancer-Related Cognitive Impairment in Older Adults with Acute Myeloid Leukemia Treated With Hypomethylating Agents and Venetoclax Chemotherapy?
