title: Vincristine-induced peripheral neuropathy in survivors of childhood acute lymphoblastic leukaemia.
abstract: BACKGROUND
  Vincristine, an essential component of childhood acute lymphoblastic leukaemia (ALL) therapeutic protocols, is associated with dose-dependent neurotoxicity, but its long-term morbidity in treated children has not been clearly elucidated. The aim of this study is to determine the prevalence of vincristine-induced peripheral neuropathy (VIPN) among Malaysian childhood ALL survivors and its impact on motor function and quality of life.
  
  
  METHODS
  Survivors of childhood ALL aged 4-18 years who had completed chemotherapy for 2 years or more were evaluated for VIPN using both the clinical Total Neuropathy Score (cTNS) and nerve conduction studies. Motor function and quality of life of the survivors were assessed via the Bruininks-Oseretsky Test of Motor Proficiency Brief Form, Second Edition (BOT-2 Brief Form) and the Paediatric Quality of Life version 4.0 Generic Core Scales (PedsQL4.0) questionnaire, respectively.
  
  
  RESULTS
  One hundred and one survivors with a duration of follow-up ranging from 2.0 to 10.3 years were recruited. Twenty-seven (26.7%) had abnormal cTNS scores and 69 (68.3%) had electrophysiological evidence of neuropathy. Of these, 16 (15.8%) had combined clinical and electrophysiological neuropathy (VIPN). Those previously treated on the intermediate- or high-risk treatment stratification arms had a higher risk of developing VIPN (67.3 vs. 32.7%; odds ratio [OR]: 9.06, 95% confidence interval [CI]: 1.14-71.86; P = 0.014). Survivors with VIPN had significantly lower quality of life scores in the physical (P = 0.024) and social domains (P = 0.039) compared with peers without VIPN, but no association with poorer motor function was observed.
  
  
  CONCLUSIONS
  Sixteen percent of ALL survivors had VIPN. VIPN should be increasingly recognised as a late effect of chemotherapy, as it significantly affects physical and social function quality of life.
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia.
authors.forename: Chee Geap
authors.initials: CG
authors.lastname: Tay
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia.
authors.forename: Vanessa Wan Mun
authors.initials: VWM
authors.lastname: Lee
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia.
authors.forename: Lai Choo
authors.initials: LC
authors.lastname: Ong
authors.affiliation: Division of Neurology, Department of Medicine, University of Malaya, Kuala Lampur, Malaysia.
authors.forename: Khean Jin
authors.initials: KJ
authors.lastname: Goh
authors.affiliation: Division of Paediatric Haematology Oncology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia.
authors.forename: Hany
authors.initials: H
authors.lastname: Ariffin
authors.affiliation: Division of Paediatric Neurology, Department of Paediatrics, University of Malaya, Kuala Lampur, Malaysia.
authors.forename: Choong Yi
authors.initials: CY
authors.lastname: Fong
mesh_terms: D000293:Adolescent; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008296:Malaysia; D008297:Male; D020258:Neurotoxicity Syndromes / Q000453:epidemiology* / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D015995:Prevalence; D017741:Survivors; D014750:Vincristine / Q000009:adverse effects*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D014750:Vincristine
keywords: acute lymphoblastic leukaemia; nerve conduction study; quality of life; vincristine-induced peripheral neuropathy