Persistence of chemotherapy-induced peripheral neuropathy despite vincristine reduction in childhood b-acute lymphoblastic leukemia

Rozalyn L. Rodwin, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, US.
John A. Kairalla, Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, US.
Emily Hibbitts, Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, US.
Meenakshi Devidas, Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, US.
Moira K. Whitley, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, US.
Caroline E. Mohrmann, Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, US.
Reuven J. Schore, Children's National Medical Center, Washington, DC, US.
Elizabeth Raetz, Department of Pediatrics, NYU Langone Medical Center, New York, NY, US.
Naomi J. Winick, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, US.
Stephen P. Hunger, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, US.
Mignon L. Loh, Department of Pediatrics, Benioff Children's Hospital, and the Helen Diller Family Comprehensive Cancer Institute, University of California, San Francisco, San Francisco, CA, US.
Marilyn J. Hockenberry, Department of Pediatrics, Baylor College of Medicine, Houston, TX, US.
Anne L. Angiolillo, Children's National Medical Center, Washington, DC, US.
Kirsten K. Ness, Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, US.
Nina S. Kadan-Lottick, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, US.

Document Type

Journal Article

Publication Date

5-12-2022

Journal

Journal of the National Cancer Institute

DOI

10.1093/jnci/djac095

Abstract

BACKGROUND: Children with B-acute lymphoblastic leukemia (B-ALL) are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Children's Oncology Group AALL0932 randomized reduction in vincristine/dexamethasone (every 4-week [VCR/DEX4] vs. 12-week [VCR/DEX12]) during maintenance in the average-risk subset of NCI standard-B-ALL (SR AR B-ALL). We longitudinally measured CIPN, overall, and by treatment group. METHODS: AALL0932 SR AR B-ALL patients ≥3 years old were evaluated at T1-T4 (end-consolidation, maintenance month-1, maintenance month-18, 12-months post-therapy). Physical/occupational therapists (PT/OT) measured motor CIPN (hand/ankle strength, dorsiflexion/plantarflexion range of motion [ROM]), sensory CIPN (finger/toe vibration and touch), and function (dexterity [Purdue Pegboard], walking efficiency [Six Minute Walk]). Proxy-reported function (Pediatric Outcome Data Collection Instrument) and quality of life (Pediatric Quality of Life Inventory) were assessed. Age/sex matched Z-scores and proportion impaired were measured longitudinally and compared between groups. RESULTS: Consent and data were obtained from 150 participants (mean age 5.1 years [SD = 1.7], 48.7% female). Among participants with completed evaluations, 81.8% had CIPN at T1 (74.5% motor, 34.1% sensory). When examining severity of PT/OT outcomes, only handgrip strength (p<.001) and walking efficiency (p=.02) improved from T1-T4 and only dorsiflexion ROM (46.7% vs. 14.7%, p=.008) and handgrip strength (22.2% vs. 37.1%, p=.03) differed in VCR/DEX4 vs. VCR/DEX12 at T4. Proxy-reported outcomes improved from T1 to T4 (P<.001) and most did not differ between groups. CONCLUSIONS: CIPN is prevalent early in B-ALL therapy and persists at least 12-months post-therapy. Most outcomes did not differ between treatment groups despite reduction in vincristine frequency. Children with B-ALL should be monitored for CIPN, even with reduced vincristine frequency.

Department

Pediatrics

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