Vincristine-induced fever in children with leukemia and lymphoma

Thirty-one children with leukemia or lymphoma treated with multi-drug chemotherapy for more than 2 years were reviewed to identify and characterize the occurrence of febrile episodes related to vincristine (VCR) injection. In nine of the 31 children, more than two febrile episodes apparently attributable to VCR during maintenance therapy were identified. No such episodes were found to have occurred during induction therapy. The median age at diagnosis of these nine children was 3.2 +/- 1.6 years, significantly lower than the 6.8 +/- 4 years of the other 22 children (P less than 0.01). No significant difference was observed between these two groups in laboratory data obtained before the VCR injections, and the drugs used in combination with VCR were apparently unrelated to the incidence of febrile episodes. All of these febrile episodes began within 24 hours after VCR injection. Peak levels of 38 degrees C to 39 degrees C occurred 6 to 24 hours after onset. The episodes also were accompanied by mild, general fatigue and a loss of appetite. They ranged in duration from half of a day to 4 days, but those persisting more than 3 days occurred in three of the five children whose regimens did not include corticosteroid. The results thus suggest that fever is an immediate reaction to the toxicity of VCR in young children, and that the duration of fever can be shortened by combining VCR with corticosteroid.