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For long-term survivors of allogeneic hematopoietic stem cell transplantation (aHSCT), persisting fatigue remains a significant problem 5 years after treatment. Fatigue is a subjective feeling of exhaustion with physical, mental and emotional manifestations, not relieved by rest. In addition to fatigue, a large proportion of cancer patients suffer from cognitive dysfunction (CD), affecting processing speed, memory and executive function which limit work capacity and everyday life. Elevated peripheral inflammatory cytokine levels correlate with fatigue after solid tumor treatment. Likewise, increased interleukin (IL)-6 and soluble tumor necrosis factor α have been reported in the peripheral blood of aHSCT survivors with fatigue. However, mechanistic studies as to the contribution of central nervous system (CNS) inflammation in the pathophysiology of fatigue remain largely absent. Current treatment for persistent fatigue and CD after cancer therapy is cognitive behavioral therapy, physical activity and education programs, aiming to reduce symptom burden. In order to detect patients that would benefit from such interventions, systematic measurement of fatigue and CD during follow-up after cancer therapy and aHSCT is necessary. The aim of this study was to correlate quantitatively assessed mental fatigue and CD to CNS inflammation. The impact of the symptoms was evaluated through measurement of quality of life and degree of employment. Importantly, we applied instruments that can be used without previous neuropsychological training. The study was conducted at Karolinska University Hospital (KUS), Huddinge, Sweden, with patients classified as 1) self-reported symptoms of mental fatigue and a men-

haematologica

Mental fatigue after allogeneic hematopoietic stem cell transplantation is associated with cognitive dysfunction, but not central nervous system inflammation