Bortezomib-based regimen affects cognitive functions in multiple myeloma patients through the VEGF pathway – Hypothesis that connects different knowledge streams

Multiple myeloma is a chronic hematological malignancy that usually affects older adults. Cancer-related cognitive impairment in multiple myeloma patients significantly impacts the everyday quality of life, however its pathophysiology remains poorly understood. Bortezomib is a commonly used drug in the treatment of multiple myeloma that does not pass the blood–brain barrier. Nevertheless, it can still affect central nervous system (CNS) through yet unknown mechanisms. This article discusses the potential effect of bortezomib-based treatment on cognitive functions in multiple myeloma patients. We hypothesize that bortezomib impairs cognition by decreasing the levels of a neuroprotective cytokine – vascular endothelial growth factor (VEGF). The generation of hypotheses about the pathophysiology of cognitive impairment paves the way for future basic and clinical studies to improve multiple myeloma management. VEGF could serve as a biomarker of cognitive dysfunction while systematic evaluation of cognition could enable early detection of cognitive impairment. Timely recognition of cognitive impairment might be crucial when selecting the most appropriate treatment. Furthermore, this could allow the implementation of preventive measures against further deterioration in cognitive function and quality of life for patients with multiple myeloma.