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. Author manuscript; available in PMC: 2024 Jun 17.
Published in final edited form as: Transplant Cell Ther. 2024 Feb 27;30(4):349–385. doi: 10.1016/j.jtct.2023.12.001

Table 10.

Neurological, Cognitive Complications, Psychosocial Health, and Quality of Life

Recommendation Grade Ref Comments
• Clinical assessment for symptoms or signs of peripheral and CNS dysfunction at 6-12 months after HCT and at least yearly thereafter 2A • Earlier and more frequent evaluation to be considered in high-risk patients.
• Careful history/examination/review of systems/medication history and assessment of time of onset of neurological signs and symptoms during survivorship visits.
• Patients with exposures to head and neck irradiation, platinum chemotherapy, aminoglycosides, or an inherited condition associated with hearing disability, audiologic evaluation within 1st year post-HCT.
• Council patients about hearing loss prevention and to seek assessment for new symptoms.
2A [408] • Follow-up evaluations as clinically warranted.
Hearing loss may be present in ADA deficiency prior to HCT and require developmental support, regular otolaryngology, and audiologicassessment post-HCT
• Perform Childhood cognitive developmental milestones ≥annually.
• Neurocognitive testing and educational/vocational progress assessment in pediatric survivors
2A • Strongly consider before returning to work/school, major changes in school (ie, moving from elementary to middle school), or changes in school performance
• Query adults annually for cognitive function changes which may be subtle.
• Neuropsychological testing and imaging should be considered in cases of reported functional impairment.
2A [302] • Inquire about difficulties multitasking, attention, remembering things or whether thinking feels slow.
• Exclude reversible causes of cognitive decline: depression, fatigue, insomnia, or medication toxicity.
• SCD: offer neurocognitive testing, if available.
• Perform CGA pre-HCT and at 6 months and 1 year post-HCT. • To identify patients more likely to benefit from enhanced toxicity risk prediction and aid treatment decision making.
• At each survivorship visit, review current symptom patterns, distress, medications, comorbidities, and physical activity. 2A • Minimum: days +100, +180, and +365, then annually.
• Discuss medication adherence and potential at each visit. 2A
• Set incremental goals for healthy diet, activity, weight management.
• Encourage adequate sleep and age-appropriate preventative measures.
• Assess those with significant physical, visual, or auditory disabilities for appropriate support services and medical equipment needs.
2A • ie, vegetables, fruits, whole grains, low in excess sugars, dried foods, red/processed meat, and dietary supplements.
• General screening of patient mental health, with standardized questionnaires (eg, NCCN distress thermometer, survivorship questionnaire). 2A [301,302] • No gold standard for screening mental health after HCT; take care to not overburden patients with PRO tools.
• To guide clinical investigations or behavioral or psychological support, particularly if multiple somatic complaints, new GVHD, major life events, or treatment changes.
• Regularly inquire to level of spousal/caregiver psychological adjustment, family functioning, educational, vocational activities, and financial toxicity. 2A • Appropriate referral if necessary.
• Offer peer support and return to work/school programs
• For AYA, provide transition of care education and plans. 2A

CGA, comprehensive geriatric assessment; PRO, patient-reported outcome.

Key references and further reading: [238,255258,267,299,301]