Clinical characteristics of vincristine-induced neurotoxicity in children with acute lymphoblastic leukemia

: Background Neurotoxicity is a severe complication of the treatment of childhood acute lymphoblastic leukemia (ALL) that affects 10–15% of patients. Vincristine-induced neuropathy (VIN) is a widely known treatment-related toxicity in children with ALL that may lead to interruption or discontinuation of chemotherapy, which may increase relapse risk. Objectives To evaluate the frequency, risk factors, clinical characteristics, and outcomes of the documented VIN among children and adolescents with ALL treated at our institution Method ology: We performed a descriptive retrospective study of children diagnosed with ALL from 2011 to 2020 to identify those who had documented VIN. Data collected on a predesigned form to include demographic and clinical characteristics, chemotherapy used and outcome. Results Sixteen out of 162 (9.87%) patients with ALL had VIN during the study period, 15 patients had vincristine induced peripheral neuropathy and one patient had vincristine induced central and peripheral neuropathy. VIN was mainly reported in induction phase (n=12 patients, 75 %) with a median duration of 27 days to develop neurotoxicity. Peripheral neuropathy was motor neuropathy recorded in 16 (100%) patients, associated with sensory neuropathy in 8(50%) patients, or associated with autonomic neuropathy in 2 (12.5%) patients. Common terminology for adverse events version 4.0 derived grades 1 ,2,3,4,5 occurred in 43.75 %, 31.25 %, 18.75 %, 6.25 %, 0 % respectively .Nine (56.25%) patients needed dose modification. There was no evidence of difference of the types of leukemia (B or T cell) on the time elapsed till the development of neurotoxicity (p=0.499). Those who developed neurotoxicity were older (p = 0.031), with a lower proportion in the low-risk group (p = 0.004). They had a higher frequency of receiving aminoglycosides and an increase in weight and SDS weight (p = <0.001, 0.009, respectively). Conclusion This retrospective study described several clinical factors that were associated with documented neurotoxicity like age , weight, protocol and antibiotics used ; however, these associations should be interpreted cautiously because of the retrospective design and the limited number of neurotoxicity events.