ORIGINAL ARTICLE Early manifestation of mild cognitive impairment in B-cell non-Hodgkin’ s lymphoma patients receiving CHOP and rituximab-CHOP chemotherapy Mohd Ashif Khan 1,2 & Kamlesh Garg 3 & Dinesh Bhurani 4 & Nidhi Bharal Agarwal 1 Received: 15 February 2016 /Accepted: 18 August 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract Existing evidence suggests that pro-inflammatory cytokines increases during chemotherapy which plays an in- termediary role in Chemotherapy related cognitive i - mpairment (CRCI) and thyroid dysregulation. Previous stud- ies 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 receiv- ing (n = 34). Effects of R-CHOP and CHOP regimen on thy- roid function, pro-inflammatory cytokines and cognitive func- tion 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 in- creased IL-6 and IL-1β with more cognitive decline and thy- roid abnormality as comparison to CHOP receiving patients. Keywords R-CHOP . CHOP . B-cell NHL . Cognitive impairment . Pro-inflammatory cytokines . Thyroid function Introduction Cognitive changes were frequently observed by many patients while undergoing chemotherapy. Some patients experienced these changes even after years of treatment, which can criti- cally affect their quality of life (Scherling and Smith, 2013). Cognitive domains which are commonly affected include im- paired memory, attention or alertness, processing speed, learn- ing and executive functioning (Boykoff et al., 2009, Munir et al., 2010, Reid-Arndt et al., 2010, Cheung et al., 2012). Between 15 and 50 % of patients with cancer experience chemotherapy-related cognitive impairment (CRCI) or “chemobrain” or “chemofog” (Mehnert et al., 2007, Vardy and Tannock, 2007, Hutchinson et al., 2012). For many pa- tients (up to 75 %), difficulties with cognitive function (CF) begins during treatment and in up to 35 %, this impairment persists for many months or years following completion of treatment (Janelsins et al., 2012). Thyroid function (TF) is thought to be vulnerable to che- motherapy, as their systemic administration has been found to harm the active hypothalamic-pituitary axis in cancer patients (Huang et al., 2013). Few prospective studies revealed that * Nidhi Bharal Agarwal nidhi.bharal@gmail.com; nidhiagarwal@jamiahamdard.ac.in 1 Centre for Translational & Clinical Research, Faculty of Science, Jamia Hamdard (Hamdard University), Hamdard Nagar, New Delhi 110062, India 2 Department of Pharmaceutical Medicine, Faculty of Pharmacy, Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India 3 Department of Pharmacology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India 4 Chief of Haemato-Oncology Services & Senior Bone Marrow Transplant Specialist, Rajiv Gandhi Cancer Institute & Research Centre, Rohini, New Delhi 110085, India Naunyn-Schmiedeberg's Arch Pharmacol DOI 10.1007/s00210-016-1290-y