Patterns and severity of vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia

Vincristine, a critical component of combination chemotherapy treatment for pediatric acute lymphoblastic leukemia (ALL), can lead to vincristine-induced peripheral neuropathy (VIPN). Longitudinal VIPN assessments were obtained over 12 months from newly diagnosed children with ALL (N=128) aged 1-18 years who received vincristine at one of four academic children's hospitals. VIPN assessments were obtained using the Total Neuropathy Score-Pediatric Vincristine (TNS (c)-PV), National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE (c)), Balis (c) grading scale, and Pediatric Neuropathic Pain Scale (c)-Five (PNPS (c)-5). Of children who provided a full TNS (c)-PV score, 85/109 (78%) developed VIPN (TNS (c)-PV 4). Mean TNS (c)-PV, grading scale, and pain scores were low. CTCAE (c)-derived grades 3 and 4 sensory and motor VIPN occurred in 1.6%/0%, and 1.9%/0% of subjects, respectively. VIPN did not resolve in months 8-12 despite decreasing dose density. VIPN was worse in older children. Partition cluster analysis revealed 2-3 patient clusters; one cluster (n=14) experienced severe VIPN. In this population, VIPN occurs more commonly than previous research suggests, persists throughout the first year of treatment, and can be severe.