Background & Aims
Chemotherapy-induced peripheral neuropathy (CIPN) stands out as one of the most frequent adverse reactions associated with cancer treatment, significantly affecting the patient’s quality of life. Several chemotherapeutic agents used in the treatment of childhood hematologic malignancies, such as vincristine, cytarabine and ifosfamide, induce peripheral neurotoxicity, giving rise to paresthesias, dysesthesias, and pain. The reported prevalence ranges between 30 and 80% in different populations; however, the impact of this severe adverse effect has yet to be assessed in our country. Hence, the primary objective of this study was to examine the prevalence and clinical characteristics of chemotherapy-induced neuropathy within an Argentinean cohort of pediatric oncology patients. Additionally, the study aimed to assess the potential associations with demographic and treatment-related variables.
Methods
In this retrospective, observational study, the electronic clinical records of all pediatric patients (aged 0-16 years) with hematologic malignancies and receiving vincristine during their treatment at our hospital during 2016 – 2022, were evaluated. The following variables were analyzed: age, gender, weight, heigh body mass index (according to WHO definition), serum albumin levels, tumor type, history of neuropathy, chemotherapy (type and number of agents received), vincristine (dose/cycle, number of cycles, total dose received), occurrence of chemotherapy-induced neuropathy, time of onset, cumulative dose of vincristine at onset, main symptoms (sensory, motor and autonomic), pain severity (evaluated using pain scales according to the patient’s age). Descriptive statistics were used to evaluate demographic data. For continuous numerical variables, all the results were expressed as mean ± SEM. Categorical variables were informed as absolute and relative frequencies and proportions.
Results
The study population consisted of 39 boys and 27 girls, aged between 8 m and 16 y. As anticipated, the predominant hematologic malignancy was precursor B-cell ALL (67%). All patients received vincristine, 96% were treated with methotrexate and 63% received cytarabine. Notably, 21% of patients received 2 neurotoxic agents, 50% were treated with 3 neurotoxic drugs, and 21% received 4 different neurotoxic drugs. Symptoms consistent with CIPN were identified in 15 children, reflecting a prevalence of 23%. These cases involved vincristine in combination with other neurotoxic drugs: all patients also received methotrexate, while 90% received both these agents plus cytarabine. No differences in CIPN prevalence were observed when comparing male and female patients. The primary symptoms manifested as pain in the lower limbs, with some patients reporting jaw or generalized pain. Pain severity was was categorized as moderate or severe in 60% and 27% of the children.
Conclusions
Among the demographic and treatment-related variables analyzed as potential risk factors, only the concurrent administration of cytarabine demonstrated a significant association with vincristine-induced peripheral neuropathy. Incidence of neuropathy did not show associations with sex, age, tumor type, or the number of neurotoxic agents administered. Given the fluctuating prevalence of pediatric chemotherapy-induced neuropathy across different regions, understanding the characteristics of the local population becomes crucial for designing and implementing effective preventive and therapeutic interventions.
References
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Presenting Author
María Florencia Coronel
Poster Authors
Maria Florencia Coronel
PhD
Instituto de Investigaciones en Medicina Traslacional Austral - CONICET
Lead Author
Delia Soriano
PhD
Institute of Research in Traslational Medicine CONICET - Austral Universtity
Lead Author
Gisella E Santos Chocler
MD
Austral University Hospital
Lead Author
Mariana A Varela
MD
Austral University Hospital
Lead Author
Topics
- Pain in Special Populations: Infants/Children