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: We performed a descriptive retrospective study of children diagnosed with ALL from 2011 to 2020 to identify those who had documented VIN. Data was 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 were diagnosed with 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 the 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 autonomic neuropathy in 2 (12.5%) patients. Common terminology criteria for adverse events version 4.03 (CTCAE v4.03) grades 1,2,3,4,5 occurred in 43.75%, 31.25%, 18.75%, 6.25%, 0% of subjects respectively. Nine (56.25%) patients needed dose modification of vincristine. There was no evidence of difference in the types of leukemia (B or T cell) in 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), a higher frequency of receiving aminoglycosides, and an increase in weight (p =