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Published on: February 9, 2016
Persistence of Chemotherapy-Induced Peripheral Neuropathy Despite Vincristine Reduction in Childhood B-Acute
Rozalyn L Rodwin1, John A Kairalla2, Emily Hibbitts2
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
Insights
Chemotherapy-induced peripheral neuropathy (CIPN) is common in children with B-acute lymphoblastic leukemia (B-ALL) early in treatment. Reducing vincristine frequency did not significantly alter most CIPN outcomes in a clinical trial.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Trials
Background:
- Children with B-acute lymphoblastic leukemia (B-ALL) face a risk of chemotherapy-induced peripheral neuropathy (CIPN).
- The Children's Oncology Group AALL0932 trial investigated reduced vincristine and dexamethasone frequency in standard-risk B-ALL.
- Longitudinal measurements of CIPN were conducted to assess its incidence and severity.
Purpose of the Study:
- To evaluate the incidence and progression of chemotherapy-induced peripheral neuropathy (CIPN) in pediatric B-acute lymphoblastic leukemia (B-ALL) patients.
- To compare CIPN outcomes between standard and reduced vincristine/dexamethasone dosing regimens during maintenance therapy.
- To assess the impact of treatment modifications on motor, sensory, and functional outcomes in young cancer patients.
Main Methods:
- 150 pediatric B-ALL patients aged 3+ years were assessed longitudinally at four time points (T1-T4).
- Evaluations included objective measures of motor (strength, range of motion) and sensory (vibration, touch) function by physical and occupational therapists.
- Patient-reported outcomes (function, quality of life) were collected using validated instruments.
Main Results:
- Chemotherapy-induced peripheral neuropathy (CIPN) was prevalent in 81.8% of patients at the end of consolidation therapy (T1).
- While some improvements in handgrip strength and walking efficiency were observed from T1 to T4, significant differences between treatment groups were limited.
- Dorsiflexion range of motion and handgrip strength showed differences at T4 between the 4-week and 12-week vincristine/dexamethasone groups.
Conclusions:
- Chemotherapy-induced peripheral neuropathy (CIPN) is a common early complication in pediatric B-acute lymphoblastic leukemia (B-ALL) that persists post-treatment.
- Reducing the frequency of vincristine and dexamethasone did not lead to significant improvements in most measured CIPN outcomes.
- Continuous monitoring for CIPN is recommended for children undergoing B-ALL treatment, even with modified chemotherapy schedules.
Background:
Children with B-acute lymphoblastic leukemia (B-ALL) are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Children's Oncology Group AALL0932 randomized reduction in vincristine and dexamethasone (every 4 weeks vs 12 weeks during maintenance in the average-risk subset of National Cancer Institute standard-B-ALL (SR AR B-ALL). We longitudinally measured CIPN, overall and by treatment group.
Methods:
AALL0932 standard-B-ALL patients aged 3 years and older were evaluated at T1-T4 (end consolidation, maintenance month 1, maintenance month 18, 12 months posttherapy). Physical and occupational therapists (PT/OT) measured motor CIPN (hand and ankle strength, dorsiflexion and plantarflexion range of motion), sensory CIPN (finger and toe vibration and touch), function (dexterity [Purdue Pegboard], and walking efficiency [Six-Minute Walk]). Proxy-reported function (Pediatric Outcome Data Collection Instrument) and quality of life (Pediatric Quality of Life Inventory) were assessed. Age- and sex-matched z scores and proportion impaired were measured longitudinally and compared between groups.
Results:
Consent and data were obtained from 150 participants (mean age = 5.1 years [SD = 1.7], 48.7% female). Among participants with completed evaluations, 81.8% had CIPN at T1 (74.5% motor, 34.1% sensory). When examining severity of PT/OT outcomes, only handgrip strength (P < .001) and walking efficiency (P = .02) improved from T1-T4, and only dorsiflexion range of motion (46.7% vs 14.7%; P = .008) and handgrip strength (22.2% vs 37.1%; P = .03) differed in vincristine and dexamethasone every 4 weeks vs vincristine and dexamethasone 12 weeks at T4. Proxy-reported outcomes improved from T1 to T4 (P < .001), and most did not differ between groups.
Conclusions:
CIPN is prevalent early in B-ALL therapy and persists at least 12 months posttherapy. Most outcomes did not differ between treatment groups despite reduction in vincristine frequency. Children with B-ALL should be monitored for CIPN, even with reduced vincristine frequency.
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