Associations of Baseline Cognitive and Psychosocial Function with Clinical Outcomes After Autologous Stem Cell Transplantation in a Multiple Myeloma Sample
4 affiliations
- 1Department of Psychiatry and Behavioral Sciences, Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- 2Department of Medicine, Division of Hematology and Oncology, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143, USA
- 3Department of Medicine, Division of Transplantation and Cellular Therapy, Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
- 4Department of Psychiatry and Behavioral Sciences, Division of Psychology, Miller School of Medicine, Miami, FL 33136, USA
Abstract
Background/Objectives: Autologous stem cell transplantation (ASCT) remains a standard frontline treatment for eligible patients with multiple myeloma and is associated with improved progression-free survival and sustained treatment responses. In addition to medical eligibility factors, pre-treatment psychosocial variables such as depression and anxiety as well as cognitive functioning may influence short- and long-term transplant outcomes. This study examined the relationship between pre-transplant psychosocial and cognitive functioning and clinical outcomes in patients with multiple myeloma undergoing ASCT. Methods: Participants (n = 245) undergoing a standardized protocol for ASCT in Miami, Florida received pre-transplant psychosocial and neuropsychological assessments. Patient-reported clinical variables and cognitive performance were related to transplant success and transplant recovery outcomes, including time to engraftment, length of hospital stay post-engraftment, and survival across four timepoints. Results: While most patients achieved engraftment within a similar timeframe, the duration of hospitalization following engraftment varied considerably. Only higher baseline trait anxiety was associated with longer post-engraftment hospital stays. In multivariate Cox regression analyses, post-engraftment length of stay was independently associated with long-term mortality when modeled as a continuous variable. In a secondary analysis using an empirically derived cutoff corresponding to stays longer than the 80th percentile (≥7 days post-engraftment), both prolonged post-engraftment hospitalization and poorer baseline delayed memory was independently associated with mortality. Descriptive survival analyses further showed that patients with prolonged post-engraftment hospitalizations had higher overall mortality and shorter survival than those with shorter post-engraftment hospital stays. Conclusions: Patients who demonstrated poorer delayed memory performance pre-transplant and prolonged hospital admission post-transplant may be most vulnerable to dying when examined at long-term follow-up. Pre-transplant psychiatric assessments provide an opportunity to identify and potentially implement supportive care interventions for patients at increased risk for cognitive impairment.
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BibTeX
@article{ruedalara2026associations,
title = {{Associations of Baseline Cognitive and Psychosocial Function with Clinical Outcomes After Autologous Stem Cell Transplantation in a Multiple Myeloma Sample}},
author = {Maria Rueda-Lara and Krishna V. Komanduri and Denise Pereira and Lazaros Lekakis and Trent Peng Wang and Antonio M. Jimenez and Amer Beitinjaneh and Noa G. Holtzman and Damian J. Green and Mark Goodman and Cara L. Benjamin and Philip D. Harvey and Brittany J. Wright},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203264},
url = {https://www.mdpi.com/2072-6694/18/20/3264},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Associations of Baseline Cognitive and Psychosocial Function with Clinical Outcomes After Autologous Stem Cell Transplantation in a Multiple Myeloma Sample
AU - Maria Rueda-Lara
AU - Krishna V. Komanduri
AU - Denise Pereira
AU - Lazaros Lekakis
AU - Trent Peng Wang
AU - Antonio M. Jimenez
AU - Amer Beitinjaneh
AU - Noa G. Holtzman
AU - Damian J. Green
AU - Mark Goodman
AU - Cara L. Benjamin
AU - Philip D. Harvey
AU - Brittany J. Wright
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203264
UR - https://www.mdpi.com/2072-6694/18/20/3264
AB - Background/Objectives: Autologous stem cell transplantation (ASCT) remains a standard frontline treatment for eligible patients with multiple myeloma and is associated with improved progression-free survival and sustained treatment responses. In addition to medical eligibility factors, pre-treatment psychosocial variables such as depression and anxiety as well as cognitive functioning may influence short- and long-term transplant outcomes. This study examined the relationship between pre-transplant psychosocial and cognitive functioning and clinical outcomes in patients with multiple myeloma undergoing ASCT. Methods: Participants (n = 245) undergoing a standardized protocol for ASCT in Miami, Florida received pre-transplant psychosocial and neuropsychological assessments. Patient-reported clinical variables and cognitive performance were related to transplant success and transplant recovery outcomes, including time to engraftment, length of hospital stay post-engraftment, and survival across four timepoints. Results: While most patients achieved engraftment within a similar timeframe, the duration of hospitalization following engraftment varied considerably. Only higher baseline trait anxiety was associated with longer post-engraftment hospital stays. In multivariate Cox regression analyses, post-engraftment length of stay was independently associated with long-term mortality when modeled as a continuous variable. In a secondary analysis using an empirically derived cutoff corresponding to stays longer than the 80th percentile (≥7 days post-engraftment), both prolonged post-engraftment hospitalization and poorer baseline delayed memory was independently associated with mortality. Descriptive survival analyses further showed that patients with prolonged post-engraftment hospitalizations had higher overall mortality and shorter survival than those with shorter post-engraftment hospital stays. Conclusions: Patients who demonstrated poorer delayed memory performance pre-transplant and prolonged hospital admission post-transplant may be most vulnerable to dying when examined at long-term follow-up. Pre-transplant psychiatric assessments provide an opportunity to identify and potentially implement supportive care interventions for patients at increased risk for cognitive impairment.
SN - 2072-6694
ER -