Patterns and severity of vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia
Ellen M Lavoie Smith1, Lang Li2, ChienWei Chiang2
1School of Nursing, University of Michigan, Ann Arbor, MI, USA.
Insights
Vincristine-induced peripheral neuropathy (VIPN) is common in children with acute lymphoblastic leukemia (ALL), affecting 78% of patients. This nerve damage can be severe and persists for up to a year.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Pharmacology
Background:
- Vincristine is essential for treating pediatric acute lymphoblastic leukemia (ALL).
- Vincristine-induced peripheral neuropathy (VIPN) is a known adverse effect.
- Understanding VIPN's incidence and severity in children is crucial for treatment management.
Purpose of the Study:
- To longitudinally assess the incidence, severity, and persistence of VIPN in children with ALL.
- To identify patient characteristics associated with VIPN development and severity.
- To evaluate the effectiveness of current assessment tools for VIPN in pediatric ALL.
Main Methods:
- Longitudinal study of 128 newly diagnosed children (aged 1-18) with ALL receiving vincristine.
- VIPN assessment using Total Neuropathy Score-Pediatric Vincristine (TNS©-PV), CTCAE©, Balis© scale, and Pediatric Neuropathic Pain Scale©-Five (PNPS©-5).
- Partition cluster analysis to identify patient subgroups with distinct VIPN experiences.
Main Results:
- 78% of children (85/109) developed VIPN (TNS©-PV ≥4).
- VIPN persisted through 12 months, with no resolution despite dose adjustments.
- Older children experienced worse VIPN; one cluster (n=14) showed severe VIPN.
- Low mean scores were observed across TNS©-PV, grading scales, and pain scores, with rare high-grade CTCAE© events.
Conclusions:
- VIPN is more common and persistent in pediatric ALL patients than previously reported.
- VIPN can be severe in a subset of pediatric ALL patients.
- VIPN requires ongoing monitoring throughout the first year of therapy, especially in older children.
Abstract:
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.
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