Glutamine for the treatment of vincristine-induced neuropathy in children and adolescents with cancer.
Vincristine is an integral treatment component of many childhood tumors with potentially dose-limiting sensory and/or motor neuropathy. Results from a pilot study on the incidence of vincristine-induced peripheral neuropathy (VIPN) as well as the efficacy and safety of glutamine in reducing signs and symptoms of VIPN in children with cancer are presented.



Fifty-six patients between the ages of 5-21 with newly diagnosed leukemia, lymphoma, extracranial solid tumor or medulloblastoma and expected to receive a minimum cumulative dose of 6 mg/m2of vincristine over a 30-week period were eligible. Patients' neurological functioning was monitored every 3 weeks using clinical history, exam, and assessment of motor functioning. Upon identification of neuropathy, patients were randomized to either glutamine (6 g/m2per dose twice daily, maximum 10 g/dose) or placebo for a 3-week period followed by 3-week wash out period (Time 3).



Forty-nine patients were fully evaluable and 100 % developed neuropathy per study definitions. No significant differences in demographics or side effects were noted between the randomized groups. The distribution of sensory neuropathy scores between the two groups was statistically significant after the intervention (p = 0.022). Children receiving glutamine also rated their quality of life (QoL) as 8.42 points higher on the PedsQL total score than those receiving placebo (p = 0.031).



Glutamine supplementation is well tolerated and associated with improvements in sensory function and self-reported overall quality of life. Future studies are warranted to confirm the efficacy of glutamine for the treatment of vincristine-related sensory neuropathy in pediatric cancer patients.
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA. sandss@mskcc.org.
Stephen
0000-0002-6196-7800
S
Sands
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.|Institute of Human Nutrition, Columbia University Medical Center, 630 West 169th Street, New York, NY, 10032, USA.
Elena J
EJ
Ladas
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Kara M
KM
Kelly
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Michael
M
Weiner
Organization and Leadership, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
Meiko
M
Lin
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Deborah Hughes
DH
Ndao
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Amie
A
Dave
Medical Oncology, Weill Cornell Breast Center, 425 East 61st Street, New York, NY, 10065, USA.
Linda T
LT
Vahdat
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
Julia Glade
JG
Bender
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult; D004311:Double-Blind Method; D005973:Glutamine / Q000627:therapeutic use; D008137:Longitudinal Studies; D009369:Neoplasms / Q000188:drug therapy; D020258:Neurotoxicity Syndromes / Q000188:drug therapy / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000188:drug therapy; D010865:Pilot Projects; D011788:Quality of Life; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D005973:Glutamine; D014750:Vincristine
Glutamine; Integrative medicine; Neuropathy; Quality of life; Supportive care