Health-Related Cognitive and Quality of Life Outcomes in Acute Leukemia Patients During Chemotherapy

Chemotherapy for acute leukemia can have an effect on cognitive functions and health-related quality of life measures. Cognitive impairment and fatigue have been described in patients with AML/MDS, even before the initiation of treatment.

To assess baseline cognitive functions, short-term cognitive evolution, and to measure both depression and health-related quality of life outcomes in adult acute leukemia patients, before and after induction treatment.

Current longitudinal-prospective study of adult acute leukemia patients treated with aggressive chemotherapy. The current study has been approved by the Institutional Ethical Committee and each patient has signed an informed consent before inclusion. Eligible patients are enrolled and are administered a comprehensive cognitive test battery, within five days after admission (T0) and after completion of induction treatment (T1). Cognitive functions assessed are attention, executive functions, motor dexterity, and verbal memory (with AVLT, COWA, PPT, SCWT, TMT). Both depression and health-related quality of life outcomes are assessed with self-report questionnaires (with CES-D and EORTC-QLQ-C30).

Thirty adult acute leukemia patients were included between 01/2009 and 07/2011. The median age was 46 years, 53% were male. The median duration of education was 13 years. 87% had AML and 13% had ALL. Baseline mean hematological values were: WBC count (8,2 10E3/uL), RBC count (3,1 10E6/uL), and HgB (9,8 g/dL). Induction treatment used in AML patients was the AML 2/95 protocol (n=22) or the HOVON 102 AML protocol (n=4), and in ALL patients the GMALL 7/03 protocol (n=4) was used. Baseline cognitive functions were normal in different cognitive domains, mainly in attention and executive functions (COWA and SCWT), except for mild cognitive deficits in verbal learning (AVLT A1–5), and especially in motor dexterity (PPT). These deficits were heterogeneous, ranging from severely impaired to good, within a specific cognitive domain. Short-term evolution on cognitive functions was observed in executive functions and verbal learning. Baseline levels of distress or depression were clinically significant, and adult acute leukemia patients showed problems on all function scales, except cognitive function, and on only two symptom scales, namely fatigue and pain. Short-term changes were found in depression, global health scale, functional scale emotional function, and symptom scale pain (also see Table).

At baseline, adult acute leukemia patients had normal cognitive functions, except for verbal learning and especially motor dexterity. Cognitive impairment and fatigue were found similar to a previous reported research. However, our data showed less impaired motor dexterity, and we also noted a partial cognitive improvement. Depression and problems on the health-related quality of life outcomes were observed at baseline, whereas at follow-up only role and social function, and fatigue were still problematic.

No relevant conflicts of interest to declare.