Post-chemotherapy cognitive impairment in hematological patients: current understanding of chemobrain in hematology

ABSTRACT

Introduction: Cognitive impairment caused by chemotherapies, a condition known as chemobrain, is a possible side effect that affects alertness, learning, memory, and concentration.

Areas covered: Chemobrain has been principally investigated as a possible side-effect among cancer patients. However, numerous drugs used to treat hematological malignancies can determine the appearance of chemobrain. In this review, we have examined some commonly used drugs for the treatment of hematological malignancies which are known to have a deleterious action on cognitive functions.

Numerous mechanisms have been suggested, comprising the direct neurotoxicity of chemotherapeutic drugs, oxidative stress, genetic predisposition, cytokine-provoked damage, histone modifications, immune alteration, and the action of chemotherapeutic on trophic factors and structural proteins of brain cells.

Expert commentary: Cognitive dysfunction provoked by the treatment of hematological diseases is an actual challenge in clinical practice. Actually, there are no totally efficient and innocuous treatments for this syndrome. It is important that further investigations specify the existence of predictors and gravity factors to pre- and post-therapy cognitive change and identify the influence of tumor treatments on the cognitive alterations in long-term, cancer survivors. Moreover, future studies are needed to analyze the interactions between genetic risk, amyloid accumulation, intrinsic brain networks, and chemotherapy.

KEYWORDS:

• Chemobrain
• chemotherapy
• cognitive impairment
• hematological diseases
• oxidative stress
• cytokine

Article Highlights

• Cognitive impairment caused by several tumor therapies is a possible side effect

• Chemobrain affects learning, memory, processing speediness, and concentration

• Several mechanisms have been proposed such as oxidative stress, genetic predisposition, cytokine action, and immune alteration

• In this review, we reported the future perspectives on therapy options for chemobrain

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The paper was supported by: Regione Sicilia, Interventi operativi per linea progettuale PSN 2015. Sviluppo dei processi di umanizzazione all’interno dei percorsi assistenziali. Commessa 1451/2017.