Chemotherapy-Induced Peripheral Neuropathy in a Subpopulation of Mexican Pediatric Patients with Acute Lymphoblastic Leukemia

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is frequent in children with acute lymphoblastic leukemia (ALL). Neurological manifestations can be grouped into one of the three functional divisions of the peripheral nervous system (PNS): sensory, motor and autonomic. One of the chemotherapeutic agents used in ALL is vincristine which has been associated with neuropathy in these children. This type of neuropathy can be transient but also leave permanent sequels that decrease patient's quality of life. Objectives: To know the frequency and type of neuropathy induced by chemotherapy in a subpopulation of Mexican pediatric patients with acute lymphoblastic leukemia. Methods: A cross-sectional study was conducted. There were included all pediatric patients with ALL diagnosed de novo from 2010 to December 31, 2013 who met the selection criteria. Descriptive statistics were used to determine the frequency and type of CIPN and information was described according to different clinical variables, type of treatment, risk classification, and ALL subtype according to the immunophenotype. Results: A total of 32 patients with acute lymphoblastic leukemia were included, mainly of early pre-B immunophenotype (93.8%), being 59.4% classified as high risk patients at the time of diagnosis. CIPN of sensory type was 78.1%, motor 34.3% and autonomic 40.6%. A significant proportion of patients (46.9%) were examined during maintenance phase. Conclusions: To our knowledge, this is the first study to report the frequency and type of CIPN in a subpopulation of Mexican children with acute lymphoblastic leukemia. Frequency of CIPN was higher than that reported in other populations. By considering that prognosis of a patient presenting CIPN could be considered as favorable after treatment suspension (in most cases), it is not always reversible and affects patient's quality of life. Therefore, it is necessary for all patients with ALL to be periodically monitored during treatment through neurological examination for detecting and immediately initiating their rehabilitation treatment.

Vincristine and Peripheral Neuropathy in Acute Lymphoblastic Leukemia Children

“…According to the morphology and risk classification, the results in this study were similar to the previous studies 13,14 . B-cell type immunophenotype and high-risk classification were 80% and 50%, respectively in study.…”

“…The previous study in Indian children showed 74 percent of B-cell type 13 . Another study form Mexico reported 93.8% of B-cell type and 59.4% of high-risk classification 14 . In regards to initial blood count at diagnosis of neuropathic patients, the result of this study is similar to the India study, in that the mean hemoglobin was 7.5 g/dl, the median white blood cell count was 6,200 per mm 3 and the median platelet count was 5,600 per mm 3 13 .…”