Post-chemotherapy cognitive impairment, also known as ‘chemobrain’, is a common neurotoxic complication induced by chemotherapy, which has been reported in many cancer survivors who have undergone chemotherapy. In this study, we aimed to explore the effects of D-neneneba dicitabine, C-nenenebb cytarabine, A-aclamycin, G-granulocyte colony-stimulating factor (D-CAG) chemotherapy on cognitive function in patients with acute myeloid leukaemia (AML) and its possible central mechanisms. Twenty patients with AML and 25 matched healthy controls (HC) were enrolled in this study. The cognitive function of patients before and after D-CAG chemotherapy was evaluated by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). The resting-state functional magnetic resonance imaging data were collected from all patients before and after chemotherapy intervention, as well as HC. Then, resting-state functional magnetic resonance imaging data were preprocessed using DPABI software package and regional homogeneity (ReHo) values of brain regions were calculated. Finally, ReHo values between groups were compared by Resting-State fMRI Data Analysis software package with t-tests and Alphasim method was performed for multiple comparison correction. Moreover, associations between ReHo values of altered brain regions and the scores of FACT-Cog were analysed by Pearson correlation. The total FACT-Cog scores and four factor scores of AML patients increased significantly after treatment. ReHo values showed no significant changes in patients before treatment when compared with HC. Compared with HC, ReHo values of the right middle frontal gyrus, inferior frontal gyrus (opercular part), middle occipital gyrus, and left praecuneus decreased significantly, while ReHo values of the left inferior temporal gyrus, right middle temporal gyrus, and hippocampus increased significantly in patients after treatment. Compared with patients before treatment, ReHo values decreased significantly in the right middle frontal gyrus, inferior frontal gyrus (opercular part), and middle and inferior occipital gyri of patients after treatment. In addition, ReHo values of the right inferior frontal gyrus (opercular part) were negatively correlated with the total scores of FACT-Cog and factor scores of perceived cognitive impairment in patients after treatment. There were also negative correlations between ReHo values of the right middle frontal gyrus and perceived cognitive impairment scores. The present study confirmed that D-CAG chemotherapy might cause impaired subjective self-reported cognitive functioning in AML patients, which might be related to the decreased function of certain regions in the right prefrontal lobe. These findings provided further understanding of the mechanisms involved in post-chemotherapy cognitive impairment and would help develop new therapeutic strategies for ‘chemobrain’ in AML patients.

中文翻译：

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D-CAG化疗方案对急性髓系白血病患者认知功能的影响：静息态功能磁共振成像研究

化疗后认知障碍，也称为“化疗脑”，是化疗引起的常见神经毒性并发症，许多接受化疗的癌症幸存者都有这种情况的报道。本研究旨在探讨D-neneneba地西他滨、C-neneneba阿糖胞苷、A-阿克拉霉素、G粒细胞集落刺激因子（D-CAG）化疗对急性髓系白血病（AML）患者认知功能的影响及其可能的中心机制。20 名 AML 患者和 25 名匹配的健康对照 (HC) 参加了这项研究。通过癌症治疗认知功能功能评估（FACT-Cog）评估D-CAG化疗前后患者的认知功能。收集化疗干预前后所有患者以及 HC 的静息态功能磁共振成像数据。然后，使用DPABI软件包对静息态功能磁共振成像数据进行预处理，并计算脑区域的区域均匀性（ReHo）值。最后通过静息态fMRI数据分析软件包进行t检验比较组间ReHo值，并采用Alphasim方法进行多重比较校正。此外，通过 Pearson 相关性分析了改变的大脑区域的 ReHo 值与 FACT-Cog 分数之间的关联。AML患者治疗后FACT-Cog总分和四因子分显着升高。与 HC 相比，治疗前患者的 ReHo 值没有显着变化。与HC相比，右侧额中回、额下回（盖部）、枕中回、左侧前丘ReHo值显着降低，而左侧颞下回、右侧颞中回、海马ReHo值显着升高在治疗后的患者中。与治疗前相比，治疗后患者右侧额中回、额下回（盖部）、枕回中下回ReHo值明显下降。此外，治疗后患者右侧额下回（盖部）ReHo值与FACT-Cog总分及感知认知障碍因子分呈负相关。右侧额中回 ReHo 值与感知认知障碍评分之间也存在负相关。本研究证实D-CAG化疗可能导致AML患者主观自我报告的认知功能受损，这可能与右前额叶某些区域的功能下降有关。这些发现进一步了解了化疗后认知障碍的机制，并将有助于为 AML 患者的“化疗脑”开发新的治疗策略。