TY - JOUR
T1 - Persistence of Chemotherapy-Induced Peripheral Neuropathy Despite Vincristine Reduction in Childhood B-Acute Lymphoblastic Leukemia
AU - Rodwin, Rozalyn L.
AU - Kairalla, John A.
AU - Hibbitts, Emily
AU - Devidas, Meenakshi
AU - Whitley, Moira K.
AU - Mohrmann, Caroline E.
AU - Schore, Reuven J.
AU - Raetz, Elizabeth
AU - Winick, Naomi J.
AU - Hunger, Stephen P.
AU - Loh, Mignon L.
AU - Hockenberry, Marilyn J.
AU - Angiolillo, Anne L.
AU - Ness, Kirsten K.
AU - Kadan-Lottick, Nina S.
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85135599585&partnerID=8YFLogxK
U2 - 10.1093/jnci/djac095
DO - 10.1093/jnci/djac095
M3 - Article
C2 - 35552709
AN - SCOPUS:85135599585
SN - 0027-8874
VL - 114
SP - 1167
EP - 1175
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 8
ER -