title: Neuropathic pain during treatment for childhood acute lymphoblastic leukemia.
abstract: BACKGROUND
  Improved cure rates for childhood acute lymphoblastic leukemia (ALL) over the past 2 decades have allowed greater attention to patients' quality of life. Neuropathic pain (NP) is an unpleasant side effect of chemotherapeutic agents for leukemia, especially vincristine.
  
  
  METHODS
  We retrospectively reviewed the records of 498 patients treated on a single protocol for ALL to investigate the risk factors, the incidence, and the use of therapeutic and prophylactic gabapentin treatment for NP.
  
  
  RESULTS
  White non-Hispanic race was the only patient variable predictive of NP. One hundred and seventy-four of 498 patients (34.9%) experienced 207 episodes of NP; 16% (28 of 174) patients experienced at least one recurrence of pain after the initial episode. No statistical significance was found in the relation between the severity (grade) of the NP episode and the cumulative dose of vincristine (P = 0.45) or the vincristine dose that immediately preceded the diagnosis (1.5 mg/m(2) versus 2.0 mg/m(2) [correction made here after initial online publication], P = 0.59). Of 180 episodes with treatment data, 62.2% (112) and 37.8% (68) were treated with gabapentin or opioids, respectively. The selection of treatment with gabapentin or opioids was not influenced by the pain intensity score at the time of diagnosis of NP (P = 0.91). The mean gabapentin dose used for 112 episodes was 15.5 mg/kg/day (SD 7.9). We found no evidence that gabapentin prevented recurrence of NP.
  
  
  CONCLUSIONS
  Our results highlight the need for prospective randomized studies to elucidate the value of gabapentin regimen for prevention or treatment of vincristine-related pain during treatment of childhood leukemia.
authors.affiliation: Division of Anesthesia and Pain Management Service, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. doralina.anghelescu@stjude.org
authors.forename: Doralina L
authors.initials: DL
authors.lastname: Anghelescu
authors.forename: Lane G
authors.initials: LG
authors.lastname: Faughnan
authors.forename: Sima
authors.initials: S
authors.lastname: Jeha
authors.forename: Mary V
authors.initials: MV
authors.lastname: Relling
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
authors.forename: John T
authors.initials: JT
authors.lastname: Sandlund
authors.forename: Cheng
authors.initials: C
authors.lastname: Cheng
authors.forename: Deqing
authors.initials: D
authors.lastname: Pei
authors.forename: Gisele
authors.initials: G
authors.lastname: Hankins
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pauley
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
mesh_terms: D000293:Adolescent; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D005260:Female; D000077206:Gabapentin; D049690:History, Ancient; D006801:Humans; D015994:Incidence; D008297:Male; D009437:Neuralgia / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014750:Vincristine / Q000009:adverse effects*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D000970:Antineoplastic Agents; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D014750:Vincristine; D000077206:Gabapentin