Associations of Baseline Cognitive and Psychosocial Function with Clinical Outcomes After Autologous Stem Cell Transplantation in a Multiple Myeloma Sample

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.