Survivorship and Patients Perspective
Tomas Kozak1, Jiri Horacek2, Heidi Mocikova, Lubica Gaherova1, Dan Fayette2, Lucie Geislerova, Ivana Karlova, Jana Markova1
3rd Faculty of Medicine, Charles University, Prague, University Hospital Kralovske Vinohrady, Prague, National Institute of Mental Health, Czech Republic
Only limited data on post-chemotherapy cognitive impairment (PCCI) are available for lymphoma in adults. Our translational project primarily focuses on the cognitive deficit related to the treatment of Hodgkin lymphoma, its structural and functional brain morphological sequelae and pathogenesis. The primary goal of the study is to establish the effect of HL and chemotherapy (2–4 cycles of chemotherapy versus 6 cycles) on cognitive performance, brain structure (GM volume, DTI) and function (fMRI connectivity). The patients are examined before the therapy, 6 and 12 months later, respectively. An animal study parallels the clinical one.
From April 2016 have been included 52 patients. We analyzed data from full neuropsychological panel in first 13 patients who underwent initial examination and 6 months follow up. Five patients were treated by less intensive therapy (2xABVD + IF Rt or 2xABVD+2xBEACOPPesc. + IF Rt), 8 patients underwent intensive treatment with 6xBEACOPPesc. Full panel consisted of: Rey's test (RAVLT), Rey-Osterriethova/Taylor's test (ROCF), Continous Performance Test (CPT), Wechsler Memory Scale (WMS), Trial Making Test TMT B, Stroop's test, Word Production Test, selected subtests of Wechsler's scale for adults (WAIS-III). Having so far limited number of subjects we analysed results with nonparametric statistics (Man-Whitney U test, Wilcoxon nonparametric test).
Results: no difference between the group of less intensive versus intensive treatment was noted at the start of the therapy. After 6 months from the start of treatment there was a difference in TMT B test (U < 0,001, p = 0,008). The test measures the ability to quick task switching, interestingly a prolonged time was noted in the less intensive therapy group. In both groups we found a decline in draw test ROCFT (Z = − 2,68; p = 0,007) and in the repeated number subtest WAIS-III (Z = − 2,23; p = 0,026).
Conclusion: in patients with HL after the 1. line therapy we found impairment in the task switching ability 6 months after the treatment initiation in those who were treated with either 2xABVD + IF Rt or 2xABVD + 2xBEACOPPesc + IF Rt, not in patiens treated with 6xBEACOPPesc. We could speculate that ABVD compounds are involved in the result but we certainly have to wait after larger ammount of subjects is analyzed. The decline in both ROCFT and WAS-III tests in both groups might reflect a worsened operation memory, but as in TMT B test we have to wait for more matured results.