Nazir Hanan F, AlFutaisi Amna, Zacharia Mathew, Elshinawy Mohamed, Mevada Surekha T, Alrawas Abdulhakim, Khater Doaa, Jaju Deepali, Wali Yasser
Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.
Pediatric Department, Faculty of Medicine, Alexandria University, Egypt.
Pediatr Blood Cancer. 2017 Dec;64(12). doi: 10.1002/pbc.26677. Epub 2017 Jun 17.
Vincristine (VCR) induced peripheral neuropathy is a common complication in children with acute lymphoblastic leukemia (ALL).
A retrospective data analysis over an interval of 10 years (2006-2016) of all children with ALL seen at Sultan Qaboos University Hospital was carried out. Electronic medical records of eligible patients were reviewed. Patients with clinical evidence of neuropathy and abnormal nerve conduction studies (NCSs) were included in the study.
Nineteen (nine females and 10 males) out of 103 pediatric patients developed VCR-related neuropathy, and their age ranged between 2.5 and 14 years. Symptoms started after 2-11 doses of VCR. All 19 patients had documented peripheral neuropathy on NCSs. The autonomic nervous system and cranial nerves affection was relatively common in our patients; two presented with bradycardia, two patients with unexplained tachycardia, and five had abdominal pain and constipation, complicated by typhlitis in two patients. One patient developed unilateral hearing loss. Two patients developed severe life-threatening cranial nerve involvement with bilateral ptosis and recurrent laryngeal nerve involvement presented as vocal cord paralysis, hoarseness of voice, frequent chocking, and aspiration episodes.
Peripheral neuropathy was the commonest form of VCR-related neuropathy. Autonomic neuropathy was relatively common in our patients. Cranial neuropathy is a serious side effect of VCR that can be severe, involving multiple cranial nerves and needs prompt recognition and management. Concomitant administration of pyridoxine and pyridostigmine does not seem to protect against further neurological damage in some patients.
长春新碱（VCR）诱发的周围神经病变是急性淋巴细胞白血病（ALL）患儿常见的并发症。
对在苏丹卡布斯大学医院就诊的所有ALL患儿进行了为期10年（2006 - 2016年）的回顾性数据分析。查阅了符合条件患者的电子病历。纳入具有神经病变临床证据和异常神经传导研究（NCS）的患者。
103例儿科患者中有19例（9例女性和10例男性）发生了VCR相关神经病变，年龄在2.5至14岁之间。症状在使用2 - 11剂VCR后出现。所有19例患者的NCS均记录有周围神经病变。自主神经系统和颅神经受累在我们的患者中相对常见；2例出现心动过缓，2例出现不明原因的心动过速，5例有腹痛和便秘，其中2例并发盲肠炎。1例患者出现单侧听力丧失。2例患者出现严重的危及生命的颅神经受累，表现为双侧上睑下垂和喉返神经受累，表现为声带麻痹、声音嘶哑、频繁呛咳和误吸发作。
周围神经病变是VCR相关神经病变最常见的形式。自主神经病变在我们的患者中相对常见。颅神经病变是VCR的严重副作用，可能很严重，累及多条颅神经，需要及时识别和处理。在一些患者中，同时给予吡哆醇和吡啶斯的明似乎不能预防进一步的神经损伤。
