There is a paucity of research on treatment-related neurotoxicity in older adults with multiple myeloma (MM) treated with high-dose chemotherapy (HDC) and autologous SCT (HDC/ASCT), despite the increasing use of this regimen. We examined resting state functional connectivity (RSFC), gray matter (GM) volume, neurocognitive function (NF), and proinflammatory cytokines (PCy) in older patients with MM pre- and post-HDC/ASCT. Eighteen patients underwent MRI, NF tests, and serum PCy measurements prior to HDC/ASCT, and fifteen patients completed a follow up five-months post-HDC/ASCT. There were significant decreases in RSFC post-HDC/ASCT in (1) the central executive network (CEN) involving theleftdorsolateral prefrontal cortex andrightposterior parietal cortex (p= 0.022) and (2) the CEN involving therightposterior parietal cortex and the salience network involving therightdorsal anterior cingulate cortex (p= 0.029). There were no significant changes in GM or NF, except for improvements in attention (Digit Span Backward,p= 0.03). There were significant increases in several PCy post-HDC/ASCT (p≤ 0.05). In conclusion, RSFC decreased in frontal, parietal, and cingulate cortices post-HDC/ASCT, NF was relatively stable, and several PCy increased. These findings are congruent with other studies in cancer patients and provide supporting evidence for the vulnerability of frontoparietal regions to chemotherapy’s adverse effects.
尽管大剂量化疗联合自体干细胞移植在老年多发性骨髓瘤患者中的应用日益增多，但关于该治疗方案相关神经毒性的研究仍较为匮乏。本研究对接受大剂量化疗/自体干细胞移植的老年多发性骨髓瘤患者治疗前后的静息态功能连接、灰质体积、神经认知功能及促炎细胞因子水平进行了系统评估。18例患者在移植前接受了磁共振成像、神经认知功能测试及血清促炎细胞因子检测，其中15例患者在移植后5个月完成随访。结果显示：移植后（1）涉及左侧背外侧前额叶皮层与右侧后顶叶皮层的中央执行网络静息态功能连接显著降低（p=0.022）；（2）涉及右侧后顶叶皮层的中央执行网络与涉及右侧背侧前扣带回的凸显网络间功能连接显著减弱（p=0.029）。除注意力功能（数字广度倒背测试，p=0.03）有所改善外，灰质体积及其他神经认知功能指标均未发生显著变化。移植后多种促炎细胞因子水平显著升高（p≤0.05）。结论：大剂量化疗/自体干细胞移植后患者额叶、顶叶及扣带回皮层功能连接降低，神经认知功能相对稳定，多种促炎细胞因子水平升高。这些发现与其他癌症研究结果一致，为额顶叶区域对化疗不良反应的易损性提供了佐证。
肿瘤(癌症)患者之家