Comparison of Intensive and Less Intensive Chemotherapy on Cognitive Impairment in Survivors of Hodgkin Lymphoma
Introduction/Background/Significance: Cognitive impairment related to cancer or chemotherapy (CRCI) is frequently reported in Hodgkin lymphoma (HL) patients, but the influence of treatment intensity remains unclear. This prospective study aimed to evaluate whether more intensive chemotherapy regimens, particularly BEACOPPesc, lead to greater cognitive decline than less intensive protocols such as ABVD.1,2
- Group 1 (n = 23): early/intermediate-stage HL treated with 4× ABVD + 30 Gy IF RT or 2× BEACOPPesc + 2× ABVD + 30 Gy IF RT
- Group 2 (n = 21): advanced-stage HL treated with 6× BEACOPPesc3,4
Neuropsychological assessments and affective/quality-of-life measures were conducted at three time points: pre-treatment, post-treatment (~6 months), and 12-month follow-up. Cognitive domains included memory, attention, processing speed, and executive function.
Results/Description/Main Outcome Measures: Results:
- Anxiety scores (BAI) were highest before treatment in the advanced-stage group (mean = 8.52), but significantly decreased by follow-up (p < 0.01).
- No associations were found between cognitive outcomes and age, sex, or education level.
Conclusions: Our findings indicate that neither disease stage nor chemotherapy intensity affects cognitive performance in HL patients. Intensive regimens like 6× BEACOPPesc did not pose greater cognitive risk than milder treatments. These results offer reassurance to clinicians and patients that effective, aggressive therapies need not be avoided for fear of exacerbating CRCI. However, further studies with larger cohorts are warranted to confirm these findings.
References
1. Trachtenberg, E.; Mashiach, T.; Hayun, B. R.; Tadmor, T.; Fisher, T.; Aharon-Peretz, J.; Dann, E.J. Cognitive impairment in Hodgkin lymphoma
survivors. Br J Haematol. 2018, 182(5), 670-678.
2. Fayette, D.; Juríčková, V.; Kozák, T.; Mociková, H.; Gaherová, L.; Fajnerová, I.; Horáček, J. Cognitive impairment associated with Hodgkin's
lymphoma and chemotherapy. Neurosci. Lett. 2023, 797:137082.
3. Ansell, S.M.; Hodgkin lymphoma: 2018 update on diagnosis, risk-stratification, and management. Am J Hematol 2018, 93, 704–715.
4. Engert, A. ABVD or BEACOPP for Advanced Hodgkin Lymphoma. J Clin Oncol 2016, 34, 1167-1169
