%0 Journal Article %J Brain Behav Immun %D 2013 %T The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients. %A McGregor, Bonnie A %A Syrjala, Karen L %A Dolan, Emily D %A Langer, Shelby L %A Redman, Mary %K Adolescent %K Adult %K Anxiety %K Depression %K Female %K Hematologic Neoplasms %K Hematopoietic Stem Cell Transplantation %K Humans %K Leukocyte Count %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K Psychiatric Status Rating Scales %K Self Report %K Sex Factors %K Stress, Psychological %K Treatment Outcome %X

Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.

%B Brain Behav Immun %V 30 Suppl %P S142-8 %8 2013 Mar %G eng %R 10.1016/j.bbi.2012.07.020 %0 Journal Article %J J Psychosoc Oncol %D 2012 %T Expressive talking among caregivers of hematopoietic stem cell transplant survivors: acceptability and concurrent subjective, objective, and physiologic indicators of emotion. %A Langer, Shelby L %A Kelly, Thomas H %A Storer, Barry E %A Hall, Suzanne P %A Lucas, Heather G %A Syrjala, Karen L %K Adaptation, Psychological %K Adult %K Caregivers %K Communication %K Expressed Emotion %K Female %K Hematopoietic Stem Cell Transplantation %K Humans %K Male %K Middle Aged %K Patient Satisfaction %K Psychotherapy %K Skin Physiological Phenomena %K Stress, Psychological %K Survivors %X

This study sought to examine the effects of an expressive talking intervention for 58 caregiving partners of hematopoietic stem cell transplant survivors, persons known to experience distress. Caregivers were randomly assigned to a three-session emotional expression (EE) or control condition. Subjective, objective, and physiologic indicators of emotion were assessed. Relative to controls, EE participants experienced more negative emotion, uttered more negative emotion words, and perceived the exercises as more helpful and meaningful. The trajectory of skin conductance and the use of cognitive mechanism words increased across EE sessions, suggesting sustained emotional engagement. Future research is warranted to determine the optimal dose and timing of EE for this population.

%B J Psychosoc Oncol %V 30 %P 294-315 %8 2012 %G eng %N 3 %R 10.1080/07347332.2012.664255 %0 Journal Article %J J Clin Oncol %D 2011 %T Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. %A Syrjala, Karen L %A Artherholt, Samantha B %A Kurland, Brenda F %A Langer, Shelby L %A Roth-Roemer, Sari %A Elrod, JoAnn Broeckel %A Dikmen, Sureyya %K Adult %K Aged %K Cognition Disorders %K Female %K Hematopoietic Stem Cell Transplantation %K Humans %K Male %K Middle Aged %K Neoplasms %K Prospective Studies %K Survivors %K Time Factors %K Transplantation, Homologous %X

PURPOSE: Research has documented cognitive deficits both before and after high-dose treatment followed by allogeneic hematopoietic cell transplantation (HCT), with partial recovery by 1 year. This study prospectively examined the trajectory and extent of long-term cognitive dysfunction, with a focus on 1 to 5 years after treatment.

PATIENTS AND METHODS: Allogeneic HCT recipients completed standardized neuropsychological tests including information processing speed (Trail Making A and Digit Symbol Substitution Test), verbal memory (Hopkins Verbal Learning Test-Revised), executive function (Controlled Oral Word Association Test and Trail Making B), and motor dexterity and speed (Grooved Pegboard). Survivors (n = 92) were retested after 80 days and 1 and 5 years after transplantation. Case-matched controls (n = 66) received testing at the 5-year time point. A Global Deficit Score (GDS) summarized overall impairment. Response profiles were analyzed using linear mixed effects models.

RESULTS: Survivors recovered significant cognitive function from post-transplantation (80 days) to 5 years in all tests (P < .0001) except verbal recall (P > .06). Between 1 and 5 years, verbal fluency improved (P = .0002), as did executive function (P < .01), but motor dexterity did not (P > .15), remaining below controls (P < .0001) and more than 0.5 standard deviation below population norms. In GDS, 41.5% of survivors and 19.7% of controls had mild or greater deficits (NcNemar test = 7.04, P = .007).

CONCLUSION: Although neurocognitive function improved from 1 to 5 years after HCT, deficits remained for more than 40% of survivors. Risk factors, mechanisms and rehabilitation strategies need to be identified for these residual deficits.

%B J Clin Oncol %V 29 %P 2397-404 %8 2011 Jun 10 %G eng %N 17 %R 10.1200/JCO.2010.33.9119