Patterns and severity of vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia.
Patterns and severity of vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia.
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DOI：
10.1111/jns.12114
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发表时间：
2015-03
期刊：
影响因子：
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通讯作者：
Renbarger J
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文献类型：
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作者：
Lavoie Smith EM;Li L;Chiang C;Thomas K;Hutchinson RJ;Wells EM;Ho RH;Skiles J;Chakraborty A;Bridges CM;Renbarger J
长春新碱是儿科急性淋巴细胞白血病（ALL）联合化疗的重要组成部分，可导致长春新碱诱导的周围神经病变（VIPN）。在四家学术儿童医院之一接受长春新碱治疗的1-18岁新诊断ALL儿童（N = 128）在12个月内进行纵向VIPN评估。采用全神经病变评分-小儿长春新碱（TNS©-PV）、美国国家癌症研究所不良事件通用术语标准（CTCAE©）、Balis©分级量表和小儿神经性疼痛量表©-5 （PNPS©-5）进行VIPN评估。在提供完整TNS©-PV评分的儿童中，85/109（78%）发生了VIPN （TNS©-PV≥4）。平均TNS©-PV、评分量表、疼痛评分均较低。CTCAE©衍生的3级和4级感觉和运动VIPN分别发生在1.6%/0%和1.9%/0%的受试者中。尽管剂量密度降低，但VIPN在8-12个月未消退。年龄较大的儿童VIPN更差。划分聚类分析发现2-3个患者聚类；1组（n = 14）出现严重VIPN。在这个人群中，VIPN的发生比以前的研究表明的更常见，持续整个治疗的第一年，并且可能很严重。
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©-PV), National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE©), Balis© grading scale, and Pediatric Neuropathic Pain Scale©–Five (PNPS©-5). Of children who provided a full TNS©-PV score, 85/109 (78%) developed VIPN (TNS©-PV ≥4). Mean TNS©-PV, grading scale, and pain scores were low. CTCAE©-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.