Early manifestation of mild cognitive impairment in B-cell non-Hodgkin's lymphoma patients receiving CHOP and rituximab-CHOP chemotherapy.

Existing evidence suggests that pro-inflammatory cytokines increases during chemotherapy which plays an intermediary role in Chemotherapy related cognitive impairment (CRCI) and thyroid dysregulation. Previous studies suggest that thyroid hormones are essential for neuronal development and neurotransmitter release. CHOP regimen has been the backbone of Non-Hodgkin's lymphoma (NHL) treatment from a decade but rituximab addition to CHOP (R-CHOP) has improved cure rates. However, their adverse event profile on behavior is not well studied on patients. In this study total 68 NHL patients were enrolled and divided equally in 2 groups as CHOP receiving (n = 34) and R-CHOP receiving (n = 34). Effects of R-CHOP and CHOP regimen on thyroid function, pro-inflammatory cytokines and cognitive function were determined at four time points that was from one day before 1st (TP0), 2nd (TP1), 3rd (TP2) and 4th (TP3) cycle of chemotherapy. Results indicated significant increase in levels of pro-inflammatory cytokines after each time point from TP0 to TP3of chemotherapy. Thyroid hormone levels i.e. T3, T4 were found significantly decreased and TSH was increased after each time point of both groups. MMSE score was found significantly decreased after each cycle of both groups. However, an inverse association was found between IL-1β levels with TSH by applying correlation coefficient. Cognitive function was decreased in patients with decreased T3 and T4 levels and increased TSH. To conclude, patients receiving R-CHOP regimen were found to have more increased IL-6 and IL-1β with more cognitive decline and thyroid abnormality as comparison to CHOP receiving patients.