IF: 0.587
Cite Score:
0.7
THOMSON REUTERS - SCOPUS

Chemotherapy-Induced Peripheral Neuropathy in a Subpopulation of Mexican Pediatric Patients with Acute Lymphoblastic Leukemia

AUTHORS

Irving Jesus Vivas-Rosales 1 , Liliana Garcia-Saavedra 2 , Jorge Alfonso Martin-Trejo 3 , Juan Manuel Mejia-Arangure 4 , Nora Patricia Victorio-Garcia 5 , Alejandro Herrera-Landero 6 , Juan Carlos Núñez-Enríquez 7 , *

1 Department of Pediatric, Pediatrics Hospital, National Medical Center (The Siglo XXI), Mexican Institute of Social Security

2 Department of Physical Medicine and Rehabilitation, Pediatrics Hospital, National Medical Center (The Siglo XXI), Mexican Institute of Social Security

3 Department of Hematology, Pediatrics Hospital, National Medical Center (The Siglo XXI), Mexican Institute of Social Security

4 Division of Evaluation of Research, Health Research Coordination, Mexican Institute of Social Security

5 Faculty of Medicine of Tampico “Dr. Alberto Romo Caballero”, Autonomous University of Tamaulipas

6 Traumatology and Orthopedics Hospital “Lomas Verdes” Mexican Institute of Social Security

7 Clinical Epidemiology Research Department, Pediatrics Hospital, National Medical Center (The Siglo XXI), Mexican Institute of Social Security

How to Cite: Vivas-Rosales I J, Garcia-Saavedra L, Martin-Trejo J A, Mejia-Arangure J M, Victorio-Garcia N P, et al. Chemotherapy-Induced Peripheral Neuropathy in a Subpopulation of Mexican Pediatric Patients with Acute Lymphoblastic Leukemia, Iran J Pediatr. 2017 ; 27(5):e11844. doi: 10.5812/ijp.11844.

ARTICLE INFORMATION

Iranian Journal of Pediatrics: 27 (5); e11844
Published Online: October 22, 2017
Article Type: Research Article
Received: April 18, 2017
Revised: June 24, 2017
Accepted: July 20, 2017
Crossmark

Crossmark

CHEKING

READ FULL TEXT
Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is frequent in children with acute lymphoblastic leukemia (ALL). Neurological manifestations can be grouped into one of the three functional divisions of the peripheral nervous system (PNS): sensory, motor and autonomic. One of the chemotherapeutic agents used in ALL is vincristine which has been associated with neuropathy in these children. This type of neuropathy can be transient but also leave permanent sequels that decrease patient’s quality of life.

Objectives: To know the frequency and type of neuropathy induced by chemotherapy in a subpopulation of Mexican pediatric patients with acute lymphoblastic leukemia.

Methods: A cross-sectional study was conducted. There were included all pediatric patients with ALL diagnosed de novo from 2010 to December 31, 2013 who met the selection criteria. Descriptive statistics were used to determine the frequency and type of CIPN and information was described according to different clinical variables, type of treatment, risk classification, and ALL subtype according to the immunophenotype.

Results: A total of 32 patients with acute lymphoblastic leukemia were included, mainly of early pre-B immunophenotype (93.8%), being 59.4% classified as high risk patients at the time of diagnosis. CIPN of sensory type was 78.1%, motor 34.3% and autonomic 40.6%. A significant proportion of patients (46.9%) were examined during maintenance phase.

Conclusions: To our knowledge, this is the first study to report the frequency and type of CIPN in a subpopulation of Mexican children with acute lymphoblastic leukemia. Frequency of CIPN was higher than that reported in other populations. By considering that prognosis of a patient presenting CIPN could be considered as favorable after treatment suspension (in most cases), it is not always reversible and affects patient’s quality of life. Therefore, it is necessary for all patients with ALL to be periodically monitored during treatment through neurological examination for detecting and immediately initiating their rehabilitation treatment.

Keywords

Antineoplastic Agents Children Leukemia Peripheral Nervous System Diseases

Copyright © 2017, Iranian Journal of Pediatrics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Leukemia is the most common type of neoplasia in children aged 0 - 14 years (1, 2). Acute lymphoblastic leukemia (ALL) is the most common subtype of leukemia. Treatment for ALL depends almost entirely on the chemotherapy regimen. In recent years, long-term complications secondary to treatment have been reported to be more frequent due to an increase in ALL survival rates.

Chemotherapy-induced peripheral neuropathy (CIPN) is defined as a lesion, inflammation, or degeneration of the peripheral nerves caused by the administration of a chemotherapeutic agent (3). Neurological manifestations can be grouped into one of the three functional divisions of the peripheral nervous system (PNS): sensory, motor and autonomic. The CIPN usually presents in nerves of greater length, that is why, the first symptoms occur in feet and hands, and progresses from distal to proximal (4).

Currently, the incidence of CIPN is 30% - 40% for all types of cancer. CIPN affects not only the quality of life but also, it can lead to interruption or decrease in the dose of chemotherapy which could potentially affect the overall survival of cancer patients (5-7).

Antineoplastic agents most frequently associated with peripheral neuropathy are taxanes, platines, vincristine, thalidomide and bortezomib (8, 9). The degree and type of neuropathy depends on the chemotherapeutic agent employed, as well as its cumulative dose. The diagnosis of CIPN is established by abnormalities in the medical history, physical examination, and nerve electrophysiology (10).

Noteworthy, so far no drug or nutritional supplement has been shown to be capable of preventing or limiting chemotherapy-induced neuropathy, highlighting the relevance to opportunely detect and treat this complication in children with leukemia (11). To our knowledge, there is no previous report on the frequency and type of CIPN in Mexican children with ALL.

2. Objectives

To report the frequency and type of chemotherapy-induced peripheral neuropathy in a sample of acute lymphoblastic leukemia in Mexican pediatric patients.

3. Methods

A descriptive cross-sectional study was conducted. We included all children with diagnosis of ALL who met the selection criteria and attended during study period (January 1st to July 30th, 2016) at either outpatient clinic or hospitalization department of the Pediatrics Hospital of the National Medical Center (The Siglo XXI), Mexican Institute of Social Security, which is a tertiary referral hospital located in Mexico City. Study was approved by the local scientific research and ethics committee with the number: R-2015-3603-77. Informed consent was obtained from child’s parents.

3.1. Selection Criteria

Inclusion criteria: Patients diagnosed with acute lymphoblastic leukemia aged > 5 years. Exclusion/elimination criteria: ALL in Down syndrome patients, patients with psychomotor retardation, cerebral palsy, being under effects of sedation and on treatment with neuropathic drugs, patients who were in intensive care, intubated, or who were not in clinical conditions to perform the neurological examination, those with any neoplasia prior to diagnosis of ALL, patients who required bone marrow transplantation, having any electrolyte disturbances during the evaluation, with altered state of consciousness, and patients with altered muscle tone, muscle stretching reflexes, in the superficial and deep sensitivity initially diagnosed, were excluded from the study. Patients who accepted to participate in the study then decided not to continue, and patients in whom neurological examination was not completed, were also excluded.

The following information was collected from clinical charts: sex, age at diagnosis, FAB classification (L1, L2, L3), risk classification (standard, intermediate, high), immunophenotype (pro-B, pre-B, mature B-cell, T-lineage, biphenotypic), chemotherapy scheme used according to the risk of ALL, phase of chemotherapy at the time of neurological examination (remission induction, consolidation, maintenance, reinduction, palliative, surveillance), relapse in the patient, site of relapse.

Chemotherapy-induced peripheral neuropathy was assessed according to ped-mTNS criteria and looking for detecting sensory, motor, combined neuropathy (12). Autonomic system was examined by asking questions about symptoms as paresthesias, muscle weakness, dizziness and lypothymia; and through the evaluation of osteotendinous reflexes. These parameters are part of the validated pediatric modified scale of chemotherapy-induced neuropathy (ped-mTNS). Muscle strength was assessed by using ped-mTNS muscular strength items. Distal muscular strength was assessed using Daniel’s scale through manual muscle examination in interossei, wrist extensors, extensor digitorum longus and ankle dorsiflexors (13).

Box 1. Box 1a
Items Included in the ped-mTNS to Assess Muscle Strength
Muscle assessed: right/left
Measured muscle level.
Big toe -/-
Ankle -/-
Abduction of phalanges -/-
Wrist extension -/-
0. Absence of contraction (Grade 0 Daniels scale: absence of contraction)
1. Contraction without movements (Grade 1 Daniels scale: visible or palpable muscle contraction)
2. Movement that does not overcome gravity (Grade 2 Daniels scale: contraction in the horizontal plane that does not overcome gravity).
3. Complete movement that overcomes gravity (Grade 3 Daniels scale: complete movement that overcomes gravity without resistance)
4. Movement with partial resistance (Grade 4 Daniels scale: movement with partial resistance).
5. Movement with maximum resistance (Grade 5 Daniels scale: Movement with maximum resistance).

aRating scale from 0 to 5 (0: no contraction, 1: visible contraction but immovable, 2: movable without gravity but immovable against it, 3: movable against gravity, 4: slight decrease, 5: normal).

Data were analyzed using SPSS software version 21. Descriptive analysis was performed according to the scale of measurement of the variables, using measures of central tendency and dispersion. For qualitative variables, simple frequencies and percentages were calculated. For quantitative variables it was determined whether the distribution was parametric or non-parametric. In case of parametric distribution, we calculated means and standard deviations, in case they did not have parametric distribution we used median and interquartile ranges.

4. Results

A total of 32 pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) were included in the present study, from which 53.1% were females with a mean age of 9.7 years (SD ± 3.1). According to the morphological classification of leukemia (FAB classification), 84.4% corresponded to L1 ALL, by immunophenotype, 93.8% were found to have an early pre-B type immunophenotype, regarding risk classification, 59.4% were high risk of relapse patients. Noteworthy, 46.9% of the study population was in the maintenance phase. Relapse patients were included, bone marrow relapse being the most frequent type (Table 1).

Table 1. Clinical Characteristics of ALL Children Included in Present Study
Clinical VariablesN = 32%
Sex
Male1546.9
Female1753.1
FAB classification
L12784.4
L2515.6
Immunophenotype
Early Pre-B3093.8
T-lineage13.1
Biphenotypic13.1
Risk classification
Standard-risk1031.3
Intermediate-risk39.4
High-risk1959.4
Chemotherapy phase
Remission induction412.5
Consolidation412.5
Maintenance1546.9
Surveillance412.5
Palliative chemotherapy13.1
Relapses412.5
Sites of relapse
Bone marrow26.2
Bone marrow and testicles13.1
Bone marrow and CNS13.1

Table 2 lists the drugs most commonly used in our study. Patients with relapse and palliative chemotherapy had received more doses of chemotherapy, generally by cycles of re-induction to remission. Table 2 lists the cumulative dose for each of the drugs used during each chemotherapy phase, based on the protocol HP 09 for Acute lymphoblastic leukemia, pediatrics hospital of national medical center (The Siglo XXI) (protocol in force).

Table 2. Cumulative Dose of Chemotherapy Agents on Different Phases of Chemotherapy According to the HP 09 ALL Protocola
Chemotherapy AgentChemotherapy Phase And Cumulative Doses Received
Induction to remissionConsolidationMaintenanceSurveillanceRelapsePalliative chemotherapy
Vincristine, mg/m26915152121
Daunorubicin, mg/m2120180300300420420
L-Asparaginase, UI/m240,000115,000190,000190,000210,000210,000
Cyclophosphamide, mg/m20200,0002000200020002000
VP-16, mg/m20600600600600600
Ifosfamide, mg/m2050005000500050006500
Methotrexate, mg/m2060006000600060006000

ashows shows the cumulative dose on each Chemotherapy phase according to the HP 09 ALL protocol.

As to the frequency of chemotherapy-induced neuropathy, in our study we found that by physical examination, 78.1% had a sensitivity alteration, 34.3% in motor exploration and 40.6% autonomic alteration (Table 3). Type of neuropathy was divided according to the subtype of affection of the peripheral nervous system (sensory, autonomic, and motor type). No statistically significant difference was found with regard to gender (male/female) for any type of neuropathy (P > 0.05).

Table 3. Frequency and Types of Chemotherapy-Induced Peripheral Neuropathy in Study Population
NeuropathyN = 32%
By interrogation
Sensory412.5
Motor412.5
Autonomic412.5
By physical examination
Sensory2578.1
Motor1134.3
Autonomic1340.6

From the findings at interrogation, 12.5% reported parestesias at some time during or after chemotherapy. 6.3% had problems to button their shirt, both patients were in maintenance phase. 6.3% referred problems with walking; both patients were in the maintenance phase. 12.5% of the patients reported having problems when going up or down the stairs. In addition, 12.5% felt dizzy when getting out of bed (Table 4).

Table 4. Frequency and Types of Neuropathic Alterations According to Chemotherapy Phase When They Were Examined
FindingsTotal PopulationChemotherapy Phases
Remission inductionConsolidationMaintenanceSurveillanceRelapseIn palliative CT
Finding in the directed interrogationn = 32%n = 4%n = 4%n = 15%n = 4%n = 4%n = 1%
Paresthesia412.5------------
Symptoms limited to the toes13.100110000000000
Symptoms up to the knee or elbow13.10000133.3000000
Symptoms above the knee or elbow26.30000266.6000000
Problems to button up your shirt26.3------------
Needs help26.300002100000000
Is walking difficult26.3------------
Not difficult13.10000150000000
Cannot walk13.10000150000000
Problems going up or down the stairs412.5------------
Not difficult13.100110000000000
Somewhat difficult13.100000000110000
Needs help13.10000150000000
Cannot go up or down the stairs13.10000150000000
Feels dizzy when getting up from bed412.5------------
A little39.411000015000110000
Almost always13.10000150000000
Findings in the physical exploration
Light touch sensitivity13.1------------
Reduced in the fingers13.100001100000000
Pin sensitivity00000000000000
Normal321004100410015100410041001100
Vibratory sensitivity2578.1------------
Normal721.9125125213.312525000
Reduced up to wrist/ankle13.1000016.7000000
Reduced up to elbow/knee412.5125125213.30012500
Reduced above elbow/knee2062.52502501066.73751251100
Right toe muscular strength825------------
Normal24754100375128037525000
Lightly decreased721.900125213.31252501100
Moderately decreased13.1000016.7000000
Left toe muscular strength825------------
Lightly decreased82500110051001100110000
Right ankle muscular strength1134.3------------
Normal2165.63753759603752501100
Lightly decreased928.1125125426.712525000
Severely decreased26.30000213.3000000
Left ankle muscular strength1134.3------------
Lightly decreased1031.3110011005831100210000
Severely decreased13.10000116.7000000
Right phalanges abduction muscular strength721.9------------
Lightly decreased618.811000048000110000
Paralysis13.10000120000000
Left phalanges abduction muscular strength721.9------------
Lightly decreased618.811000048000110000
Paralysis13.10000120000000
Right wrist extension muscular strength721.9------------
Lightly decreased618.81100003751100110000
Paralysis13.10000125000000
Left wrist extension muscular strength721.9------------
Lightly decreased618.81100003751100110000
Paralysis13.10000125000000
Right ankle deep reflex1340.6------------
Normal1959.4250250746.737541001100
Decreased1031.3125125746.71250000
Absent13.10012500000000
All reflexes absent26.31250016,7000000
Left ankle deep reflex1340.6-------------
Normal1959.4250250746.737541001100
Decreased1031.3125125746.71250000
Absent13.10012500000000
All reflexes absent26.31250016.7000000
Right knee deep reflex618.8------------
Normal2681.33752501280410041001100
Decreased26.30000213.3000000
Absent26.30025000000000
All reflexes absent26.31250016.7000000
Left knee deep reflex618.8------------
Normal2681.33752501280410041001100
Decreased26.30000213.3000000
Absent26.30025000000000
All reflexes absent26.31250016.7000000

Regarding the findings in physical examination, only one patient presented alteration to the light touch at the level of the toes. In the exploration 78.1% had alterations in vibratory sensitivity, 34.3% were found with an alteration in right ankle muscle strength. On the contralateral side, 34.3% presented alteration in strength similar to the right limb. The abduction muscle strength of the right phalanges was altered in 21.9% of the total patients. The distribution and percentages were similar in the exploration of muscle strength for abduction of the left phalanges. Muscle strength for right wrist extension was altered in 21.9% of the total patients. The findings were similar to the physical examination of muscle strength for the left wrist extension. The exploration of the right Achilles reflex was altered in 40.6%. The percentages and distribution were similar for the deep left Achilles reflex. In the right patellar reflex, 18.8% were altered. The percentages and distribution for chemotherapy were similar for the left patellar reflex (Table 4).

5. Discussion

The present study has allowed us to describe for the first time the type and frequency of chemotherapy-induced peripheral neuropathy in pediatric patients with acute lymphoblastic leukemia treated at a Mexican third level hospital.

Ramcharden et al. found in pediatric survivors of leukemia who had no subjective symptoms of neuropathy despite having an exploration or nerve conduction studies altered (14). In the present study, we observed that chemotherapy-induced peripheral neuropathy can be found even before the end of treatment. Thus, compared to the findings reported by Ramchandren et al., we found nerve alterations up to almost 80% versus 29.7% by these authors.

Regarding the cumulative dose, it has been established that dosages of 1.4 mg/m2 dose of vincristine may be safe (15-17). However, most of our patients have cumulative dose of this drug, which has been linked to the risk of chemotherapy-induced neuropathy. Another example, is methotrexate, which shows that high doses, greater than 1.5 g/m2 is related to adverse effects (18). Some of the chemotherapeutic agents established in therapy for ALL such as ARA-C, have yet to establish the cumulative doses for risk of peripheral neurotoxicity (19, 20).

Martinez-Cayuelas et al., reported the frequency of neuropathy during the different phases of leukemia treatment and after the end of it. They observed that most of the neurological complications were presented in the induction phase (43%), consolidation (17%) or maintenance (13%), and only a low percentage occurred at the beginning of the disease, after treatment and in palliative care phase (20). In our series, 4 patients (12.5%) reported paresthesias, one patient in the consolidation phase and 3 in the maintenance phase. In addition, 4 patients (12.5%) reported motor type problems, one in consolidation, two in maintenance and another with relapse in maintenance phase. Regarding physical examination, 25 individuals (71.8%) presented alteration in vibratory sensitivity. This alteration was greater in maintenance phase with a number of 15 individuals (48.6%) of our series, unlike what these authors found where the greatest affection was given in the induction phase in 43% of the cases versus 4 patients (12.5%) in our study. However, this may be affected by the size of our sample, since the largest population was in the maintenance phase, constituting a number of 15 individuals (46.9%) against 4 individuals (12.5%) in the remission induction phase in our series.

Of the neuropathies found by Martinez-Cayuelas et al., 31% of the population reported pain and weakness of the lower limbs. In our series, the major alteration was of a vibratory type with affection in 25 (80%) patients of the population. Although vibratory sensitivity is not referred to as pain or weakness, these sensory and motor alterations respectively, correspond to a type of proprioceptive alteration that is also part of the peripheral nervous system and is included in the sensory neuropathy, therefore, the findings are similar to other studies constituting peripheral neuropathy the main condition (21-23). In our series, in addition to the physical examination, reference was made to neuropathy symptoms, this way, motor-type problems were reported in 4 (12.5%) individuals of our population, and 4 (12.5%) patients reported paresthesias, this is different to the findings of Martinez-Cayuelas et al., where this type of alteration was reported in approximately 30% of patients. This could be explained by the size of our sample, which is smaller but the findings of sensory and motor alteration are the main ones in both series.

In 2010, Velasco R. and Bruna J., in a review article, commened that chemotherapy-induced peripheral neuropathy is the most frequent neurological complication of cancer treatment, affecting approximately one-third of patients (24). This is similar to the findings by E. Martinez-Cayuelas, et al., where 30% of their patients had sensory and motor type complications (18). In our study, in a sample of 32 patients, the distribution was approximately 25 (80%) patients with a sensory type, 11 (34%) patients with a motor type and 13 (40%) individuals with autonomic type. This shows that the prevalence of chemotherapy-induced neuropathy in our patients is higher than that reported in other studies, even when the chemotherapy phases in which these alterations were detected are taken into account. We do not know why this higher frequency of neuropathy since chemotherapy doses adjusted to the weight of the patient were used.

In studies that have been conducted to measure chemotherapy-induced neuropathy in children with acute lymphoblastic leukemia, the most frequent cause has been vincristine treatment, which turned out to be dose dependent, and in which it has been observed that most of these complications have been found two weeks after administration of vincristine (17) Lavoie Smith et al, used the Neuropathy score pediatric vincristine scale in a total of 128 patients, receiving 1.5 mg/m2 of vincristine, found a 78% of peripheral neuropathy (25) which is exactly similar to the finding observed in present study.

5.1. Study Limitations

One of the limitations of our study is the research design since it is a cross-sectional descriptive study in which it was not possible to determine if these patients already had neuropathy at the time of the exploration since previous measurements had not been made. Other limitation could be the small sample size of ALL patients examined; however, we included all those patients attended during study period at outpatient clinic and/or during hospitalization and who met selection criteria. We consider that the next step is to design multicenter, prospective research studies that include a larger sample size in order to determine the prevalence of chemotherapy-induced neuropathy in our population.

Moreover, we were not able to establish what type of neurotoxic agent was responsible for the neuropathy. It is well known that corticosteroids may cause weakness and induce myopathy and this could have affected our results. It is important to highlight that all patients in present study daily received as part of their chemotherapy treatment a systemic steroid at a high dose during the first 4 weeks (phase of remission induction). However, there are two important issues that have to be taken into consideration: first, only 4 (12.5%) patients were examined during this phase of treatment (induction to remission phase), being the majority of patients in phases of treatment where systemic steroids are not used; and second, it should be noted that the evaluation of muscle strength in our study was based mainly on distal musculature and not on proximal, which according to the literature characterize the steroid-induced myopathy (26).

Another possible limitation of our study may have been the failure to confirm peripheral neuropathy with electrodiagnostic studies. However, until date there is no universally accepted tool for diagnosing chemotherapy-induced peripheral neuropathy in children and several scales (including or not electrodiagnostic studies) have been used to detect this complication in children receiving chemotherapy (12, 27, 28). Some examples are: the total neuropathy scale (TNS), clinical neuropathy scale, and the modified neuropathy scale. Recently, the modified pediatric scale for total neuropathy (ped-mTNS) was validated as a variant of TNS (for not including electrodiagnostic studies), and has been considered as a reliable and valid measure for detecting CIPN in children with cancer and leukemia (27, 28). Moreover, it has been also reported that sensitivity to detect CIPN with this scale is greater than with previous ones. For this reason, we used in present research the Ped-mTNS wich consisted of three sets of questions about sensory symptoms, pain, motor function and autonomic function, as well as a five-part neurological examination that includes light touch explored by monofilament, biotensor vibration, pin-prick sensitivity, distal force through manual muscle examination (performed on interossei, wrist extensors, extensor digitorum muscle and ankle dorsiflexors), and deep tendon reflexes (27, 28).

5.2. Conclusions

To our knowledge, this is the first study to report the frequency and type of CIPN in a subpopulation of Mexican children with acute lymphoblastic leukemia. Frequency of CIPN was higher than that reported in other populations. By considering that prognosis of a patient presenting CIPN could be considered as favorable after treatment suspension (in most cases), it is not always reversible and affects patient’s quality of life. Therefore, it is necessary for all patients with ALL to be periodically monitored during treatment through neurological examination for detecting and immediately initiating their rehabilitation treatment.

Acknowledgements

References

  • 1.

    Fajardo-Gutierrez A, Mejía-Aranguré M, Gómez-Delgado A. Epidemiología de las neoplasias malignas en ni-os residentes del Distrito Federal (1982-1991) [In Spanish]. Bol Med Hosp Infant Mex. 1995; 52 : 507 -16

  • 2.

    Fajardo-Gutierrez A, Mejia-Arangure JM, Hernandez-Cruz L, Mendoza-Sanchez HF, Garduno-Espinosa J, Martinez-Garcia MC. [Descriptive epidemiology of malignant tumors in children]. Rev Panam Salud Publica. 1999; 6(2) : 75 -88 [PubMed]

  • 3.

    Armstrong T, Almadrones L, Gilbert MR. Chemotherapy-induced peripheral neuropathy. Oncol Nurs Forum. 2005; 32(2) : 305 -11 [DOI][PubMed]

  • 4.

    Gilchrist L. Chemotherapy-induced peripheral neuropathy in pediatric cancer patients. Semin Pediatr Neurol. 2012; 19(1) : 9 -17 [DOI][PubMed]

  • 5.

    Cavaletti G, Bogliun G, Marzorati L, Tredici G, Colombo N, Parma G, et al. Long-term peripheral neurotoxicity of cisplatin in patients with successfully treated epithelial ovarian cancer. Anticancer Res. 1994; 14(3B) : 1287 -92 [PubMed]

  • 6.

    Wolf S, Barton D, Kottschade L, Grothey A, Loprinzi C. Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Eur J Cancer. 2008; 44(11) : 1507 -15 [DOI][PubMed]

  • 7.

    Mileshkin L, Stark R, Day B, Seymour JF, Zeldis JB, Prince HM. Development of neuropathy in patients with myeloma treated with thalidomide: patterns of occurrence and the role of electrophysiologic monitoring. J Clin Oncol. 2006; 24(27) : 4507 -14 [DOI][PubMed]

  • 8.

    Cardona AF, Ortiz LD, Reveiz L. Neuropatía inducida por el tratamiento médico del cáncer. Med UIS. 2010; 23(2) : 103 -27

  • 9.

    Argyriou AA, Bruna J, Marmiroli P, Cavaletti G. Chemotherapy-induced peripheral neurotoxicity (CIPN): an update. Crit Rev Oncol Hematol. 2012; 82(1) : 51 -77 [DOI][PubMed]

  • 10.

    England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2005; 64(2) : 199 -207 [DOI][PubMed]

  • 11.

    Albers J, Chaudhry V, Cavaletti G, Donehower R. Interventions for preventing neuropathy caused by cisplatin and related compounds. Cochrane Database Syst Rev. 2007; (1)[DOI][PubMed]

  • 12.

    Gilchrist LS, Tanner L. The pediatric-modified total neuropathy score: a reliable and valid measure of chemotherapy-induced peripheral neuropathy in children with non-CNS cancers. Support Care Cancer. 2013; 21(3) : 847 -56 [DOI][PubMed]

  • 13.

    Hislop HJ, Montgomery J. Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination. 1995; : 2 -6

  • 14.

    Ramchandren S, Leonard M, Mody RJ, Donohue JE, Moyer J, Hutchinson R, et al. Peripheral neuropathy in survivors of childhood acute lymphoblastic leukemia. J Peripher Nerv Syst. 2009; 14(3) : 184 -9 [DOI][PubMed]

  • 15.

    Legha SS. Vincristine neurotoxicity. Pathophysiology and management. Med Toxicol. 1986; 1(6) : 421 -7 [DOI][PubMed]

  • 16.

    Sandler SG, Tobin W, Henderson ES. Vincristine-induced neuropathy. A clinical study of fifty leukemic patients. Neurology. 1969; 19(4) : 367 -74 [PubMed]

  • 17.

    Díaz-Jaimes E, Pe-aloza-Ochoa L, Parada-Onoko PM. Electrophysiological changes of peripheral neuropathy with vincristine after a physical therapy program in pediatric patients with acute lymphoblastic leukemia. Bol Med Hosp Infant Mex. 2009; 66(6) : 529 -36

  • 18.

    De Braganca KC, Packer RJ. Neurotoxicity of chemotherapeutic and biologic agents in children with cancer. Curr Neurol Neurosci Rep. 2008; 8(2) : 114 -22 [PubMed]

  • 19.

    Openshaw H, Slatkin NE, Stein AS, Hinton DR, Forman SJ. Acute polyneuropathy after high dose cytosine arabinoside in patients with leukemia. Cancer. 1996; 78(9) : 1899 -905 [PubMed]

  • 20.

    Martinez-Cayuelas E, Domingo-Jimenez R, Pascual-Gazquez JF, Martinez-Salcedo E, Alarcon-Martinez H, Bermudez-Cortes M, et al. [Neurological complications in the population of children with leukaemia]. Rev Neurol. 2015; 60(3) : 108 -14 [PubMed]

  • 21.

    Vagace JM, de la Maya MD, Caceres-Marzal C, Gonzalez de Murillo S, Gervasini G. Central nervous system chemotoxicity during treatment of pediatric acute lymphoblastic leukemia/lymphoma. Crit Rev Oncol Hematol. 2012; 84(2) : 274 -86 [DOI][PubMed]

  • 22.

    Lo Nigro L, Di Cataldo A, Schiliro G. Acute neurotoxicity in children with B-lineage acute lymphoblastic leukemia (B-ALL) treated with intermediate risk protocols. Med Pediatr Oncol. 2000; 35(5) : 449 -55 [PubMed]

  • 23.

    Parasole R, Petruzziello F, Menna G, Mangione A, Cianciulli E, Buffardi S, et al. Central nervous system complications during treatment of acute lymphoblastic leukemia in a single pediatric institution. Leuk Lymphoma. 2010; 51(6) : 1063 -71 [DOI][PubMed]

  • 24.

    Velasco R, Bruna J. [Chemotherapy-induced peripheral neuropathy: an unresolved issue]. Neurologia. 2010; 25(2) : 116 -31 [DOI][PubMed]

  • 25.

    Lavoie Smith EM, Li L, Chiang C, Thomas K, Hutchinson RJ, Wells EM, et al. Patterns and severity of vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia. J Peripher Nerv Syst. 2015; 20(1) : 37 -46 [DOI][PubMed]

  • 26.

    Perrot S, Le Jeunne C. [Steroid-induced myopathy]. Presse Med. 2012; 41(4) : 422 -6 [DOI][PubMed]

  • 27.

    Farquhar-Smith P. Chemotherapy-induced neuropathic pain. Curr Opin Support Palliat Care. 2011; 5(1) : 1 -7 [DOI][PubMed]

  • 28.

    Gilchrist LS, Marais L, Tanner L. Comparison of two chemotherapy-induced peripheral neuropathy measurement approaches in children. Support Care Cancer. 2014; 22(2) : 359 -66 [DOI][PubMed]

  • COMMENTS

    LEAVE A COMMENT HERE: