Effect of pyridoxine plus pyridostigmine treatment on vincristine-induced peripheral neuropathy in pediatric patients with acute lymphoblastic leukemia: a single-center experience

• Published in: Neurological sciences Vol. 42; no. 9; pp. 3681 - 3686
• Main Authors: Aydin Köker, Sultan, Gözmen, Salih, Demirağ, Bengü, Ünalp, Aycan, Karapinar, Tuba Hilkay, Oymak, Yeşim, Gürbüz, Gürkan, Öner, Ecem İpek, Vergin, Raziye Canan
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-09-2021; Springer Nature B.V
• Subjects: Acute lymphoblastic leukemia; Chemotherapy; Diagnosis; Leukemia; Lymphatic leukemia; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Neurotoxicity; Original Article; Patients; Pediatrics; Peripheral neuropathy; Psychiatry; Pyridostigmine; Pyridoxine; Risk groups; Vincristine; Acute lymphoblastic leukemia; Children pyridoxine plus pyridostigmine treatment; Vincristine-induced neuropathy
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-020-04970-w

Background
Vincristine (VCR), which is a key component of chemotherapy, is important for survival. VCR is associated with a well-known side effect, including neurotoxicity.
Aims
The aim of this study was to evaluate the features of vincristine-induced peripheral neuropathy (VIPN) and the effectiveness of pyridoxine plus pyridostigmine therapy in children with acute lymphoblastic leukemia.
Methods
The WHO and NCI CTCAE neurotoxicity scorings were used to evaluate VIPN at diagnosis, in the first month, and after the third month of the treatment. The clinical features of 23 patients having acute lymphoblastic leukemia with VIPN during the period of July 2013–February 2016 were prospectively evaluated.
Results
The mean age was 72.8 ± 51.6 months, and 26.1%, 56.5%, and 17.4% were in standard, moderate, and high-risk groups, respectively. Neuropathy frequently occurred at induction (82.6%) and reinduction (17.4%) of the protocol. Drop foot (82.6%), leg pain (82.6%), and difficulty in walking (82.6%) were observed. The mean total cumulative dose of neuropathy occurrence was 5.6 ± 2.03 mg/m
2
. Our study showed that both the WHO and NCI CTCAE scorings were significantly improved via pyridoxine plus pyridostigmine therapy.
Conclusion
The WHO and NCI CTCAE scorings may be used for evaluating neuropathy at diagnosis and follow-up of neurotoxicity with treatment. Pyridoxine plus pyridostigmine therapy may be an effective option in the treatment of VIPN.