A Study of Functional Cognition Following Chimeric Antigen Receptor T-Cell (CAR-T) Therapy

Research

Objectives: To evaluate the impact of Chimeric Antigen Receptor T-Cell (CAR-T) Therapy on functional cognition.

Design: Patients admitted for CAR-T completed the Controlled Oral Word Association Test (COWAT), Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part A and B (TMT), Patient-Reported Outcomes Measurement Information System Cognitive Function- Abilities Short Form 4a (PROMIS), and the Activity Measure for Post-Acute Care Inpatient Daily Activity Short Form (AM-PAC) as part of standard occupational therapy inpatient evaluation prior to receiving CAR-T treatment. Outcome measures were repeated 0-3 days prior to the patient’s discharge from the hospital.

Setting: The study was conducted in an acute care oncology setting.

Participants: 89 participants who underwent inpatient CAR-T treatment.

Interventions: The study followed an observational design with standard of care interventions delivered based on impairments identified at the time of occupational therapy evaluation.

Main Outcome Measures: COWAT, HVLT-R, TMT, PROMIS, and AM-PAC

Results: Trails B data revealed a statistically significant decline from evaluation (z-score of -0.12) to discharge (z-score of -0.74), signifying a decline in executive functioning (p=0.01). The COWAT data exhibited a significant decline from evaluation (z-score of -0.41) to discharge (z-score of -0.75), indicating a decline in both executive functioning and oral fluency (p=0.02). These assessments were normalized using z-scores to control for the effects of age. There was a significant difference between the general population (z-score of 0) and patients who received CAR-T treatment both before and after treatment (z-score of -1.41 and -1.55) (p=0.04), suggesting the impact of cancer treatment on memory. Additionally, patients over the age of 50 exhibited a more pronounced cognitive decline following CAR-T treatment compared to those below the age of 50.

Conclusion: Patients who underwent CAR-T treatment displayed diminished memory at the time of hospital admission, with further decline upon discharge, particularly in the domains of executive functioning and oral fluency. Notably, self-reported cognitive deficits, as indicated by PROMIS data both before and after CAR-T treatment emphasize a potential gap in care, highlighting the need for timely cognitive assessment and intervention throughout the continuum of cancer care.