Literature Scan
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between patients and controls , the researchers also examined differences in cognitive function between men and women , between patients with Hodgkin lymphoma versus non-Hodgkin lymphoma ( n = 186 ), and by disease subtype .
Cognitive assessments were performed at the following intervals : to controls ( p = 0.02 ). In tests of executive function , patients performed lower than controls ( p = 0.02 ). Patients with lymphoma also performed significantly less well from A1 to A2 as well as from A1 to A3 on the phone-based Digits Backward test ( p < 0.001 and p = 0.01 , respectively ) and Category Fluency tests ( all p < 0.001 ). with controls ( 37.8 % vs . 15.1 %; p < 0.001 ). The researchers noted that women with lymphoma reported statistically significantly more perceived impairment compared to men with lymphoma and controls .
Limitations of this study included its relatively small sample sizes for subgroups , which
• baseline ( A1 ): within 7 days of the first chemotherapy session
• post-chemotherapy ( A2 ): within 1 month after the last chemotherapy session
• follow-up ( A3 ): at 6 months after the last chemotherapy session
At baseline , patients with lymphoma self-reported significantly more issues on the FACT-Cog scale ( perceived cognitive impairment [ PCI ] and total scores ) compared with sex-matched controls ( p < 0.05 ). In addition , patients with lymphoma reported significantly more attentional difficulty ( p = 0.01 ) and significantly greater PCI from A1 to A2 , as well as from A1 to A3 ( p < 0.03 ).
There was no difference in baseline objective memory test scores between patients with lymphoma and controls . From periods A1 to A2 , however , patients performed worse than controls on tests of immediate recall ( p = 0.01 ). Patients also showed less improvement in immediate recall over time from periods A1 to A3 ( p = 0.02 ). Patients with lymphoma also had poorer performance from A1 to A2 and from A1 to A3 on a phone-based immediate and delayed recall test ( p < 0.001 ).
Patients with lymphoma also performed less well on tests for attention from A1 to A2 relative
“ [ Cognitive problems are ] something for clinicians treating patients with lymphoma to be aware of and monitor during treatment .”
In the subgroup analysis according to patient sex , the researchers observed that women with lymphoma had a higher perceived impairment in cognition than men with lymphoma , relative to controls , from A1 to A2 and from A1 to A3 ( p = 0.007 ).
Looking specifically at the female study population , 51.3 % of women with lymphoma reported a perceived decline in FACT-Cog PCI scores compared with only 14.5 % of women in the control group ( p < 0.001 ). At six-month follow-up , a higher proportion of women with lymphoma reported decline in FACT-Cog scores compared with women in the control arm ( 54.8 % vs . 11.7 %; p < 0.001 ). In the male population , more men with lymphoma reported declines in FACT-Cog scores at six months following chemotherapy compared
— Michelle C . Janelsins , PhD
the researchers suggest may have led to a lack of difference in cognitive function outcomes between patients by treatment regimen or lymphoma type . Additionally , the study is limited by its short follow-up period . “ Future studies should be designed to address differences of the impact of disease subtypes and treatment on cognitive function , including those receiving more targeted therapies and immunotherapy ,” the authors concluded .
The authors report no relevant conflicts of interest .
Reference Janelsins MC , Mohamed M , Peppone LJ , et al . Longitudinal changes in cognitive function in a nationwide cohort study of patients with lymphoma treated with chemotherapy [ published online ahead of print , 2021 Jul 13 ]. J Natl Cancer Inst . doi : 10.1093 / jnci / djab133 .
Therapeutic Anticoagulation Does Not Prevent PVT Recurrence After Liver Transplant
In patients with cirrhosis who have portal vein thrombosis ( PVT ) and undergo liver transplantation , therapeutic anticoagulation was associated with significantly higher rates of bleeding and longer index hospitalization than in patients who did not receive anticoagulation . Additionally , anticoagulation did not prevent PVT recurrence after transplant , suggesting prophylactic use of this therapy is not effective in this patient population . This is according to recent study results published in the Journal of Thrombosis and Haemostasis .
When possible , therapeutic anticoagulation is recommended to manage PVT before liver transplant , but few studies have established the utility of this regimen for the prevention of PVT recurrence .
A retrospective study led by Isabel Bos , MD , of the University of Groningen in the Netherlands , examined all adult liver transplants performed at two high-volume liver transplant centers in Europe . All patients in the study had cirrhosis and thrombosis of the portal vein without complete extension in the spleno-mesenteric confluence or superior mesenteric vein .
Between the study years of 2003 and 2018 , a total of 2,502 patients underwent liver transplantations at the European centers . Approximately 14.7 % of these patients ( n = 369 ) had a PVT prior to or at the time of transplant .
Researchers selected 235 patients with PVT for the final analysis . In this cohort , 113 patients ( 48.1 %) received anticoagulation for a median duration of three months and 122 patients ( 51.9 %) did not receive anticoagulation . The overall median follow-up was 59.8 months , with significant difference observed between the two groups ( 72.3 vs . 49.4 months ; p = 0.34 ).
Therapeutic anticoagulation consisted of a short initial course of heparin started in the ICU as soon as possible , followed by oral administration of vitamin K antagonist with an international normalized ratio target between 2 and 3 for approximately three months . None of the patients received direct oral anticoagulants .
Patients who received therapeutic anticoagulation were significantly younger than those who didn ’ t receive anticoagulation ( 58 vs . 60 years , respectively ; p = 0.045 ).
The group of patients who received therapeutic anticoagulation had a higher rate of bleeding events ( 23 % vs . 4.1 %; p < 0.01 ) and a longer initial hospitalization ( 21 vs . 17.5 days ; p < 0.01 ).
During the first year following liver transplantation , PVT recurrence was reported in 3.8 % of cases , but there was no significant difference in recurrence between those who received anticoagulation and those who didn ’ t ( 5.1 % vs . 2.5 %; p = 0.39 ).
At one year , residual thrombus was diagnosed in four patients who received therapeutic anticoagulation and three patients who did not . None of these patients experienced PVT recurrence .
44 ASH Clinical News October 2021