Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
Department of Biostatistics, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA.
J Natl Cancer Inst. 2022 Aug 8;114(8):1167-1175. doi: 10.1093/jnci/djac095.
Children with B-acute lymphoblastic leukemia (B-ALL) are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Children's Oncology Group AALL0932 randomized reduction in vincristine and dexamethasone (every 4 weeks vs 12 weeks during maintenance in the average-risk subset of National Cancer Institute standard-B-ALL (SR AR B-ALL). We longitudinally measured CIPN, overall and by treatment group.
AALL0932 standard-B-ALL patients aged 3 years and older were evaluated at T1-T4 (end consolidation, maintenance month 1, maintenance month 18, 12 months posttherapy). Physical and occupational therapists (PT/OT) measured motor CIPN (hand and ankle strength, dorsiflexion and plantarflexion range of motion), sensory CIPN (finger and toe vibration and touch), function (dexterity [Purdue Pegboard], and walking efficiency [Six-Minute Walk]). Proxy-reported function (Pediatric Outcome Data Collection Instrument) and quality of life (Pediatric Quality of Life Inventory) were assessed. Age- and sex-matched z scores and proportion impaired were measured longitudinally and compared between groups.
Consent and data were obtained from 150 participants (mean age = 5.1 years [SD = 1.7], 48.7% female). Among participants with completed evaluations, 81.8% had CIPN at T1 (74.5% motor, 34.1% sensory). When examining severity of PT/OT outcomes, only handgrip strength (P < .001) and walking efficiency (P = .02) improved from T1-T4, and only dorsiflexion range of motion (46.7% vs 14.7%; P = .008) and handgrip strength (22.2% vs 37.1%; P = .03) differed in vincristine and dexamethasone every 4 weeks vs vincristine and dexamethasone 12 weeks at T4. Proxy-reported outcomes improved from T1 to T4 (P < .001), and most did not differ between groups.
CIPN is prevalent early in B-ALL therapy and persists at least 12 months posttherapy. Most outcomes did not differ between treatment groups despite reduction in vincristine frequency. Children with B-ALL should be monitored for CIPN, even with reduced vincristine frequency.
患有 B 急性淋巴细胞白血病（B-ALL）的儿童有患化疗引起的周围神经病（CIPN）的风险。儿童肿瘤学组 AALL0932 将长春新碱和地塞米松的剂量减少（在平均风险亚组的国家癌症研究所标准 B-ALL（SR AR B-ALL）中，维持期每 4 周与 12 周）。我们纵向测量 CIPN，总体和按治疗组。
AALL0932 标准 B-ALL 患者年龄≥3 岁，在 T1-T4（巩固期末、维持期第 1 个月、维持期第 18 个月、治疗后 12 个月）进行评估。物理治疗师（PT/OT）测量运动性 CIPN（手和踝关节力量、背屈和跖屈运动范围）、感觉性 CIPN（手指和脚趾振动和触觉）、功能（灵巧性[Purdue 钉板]和行走效率[六分钟步行测试]）。代理报告的功能（儿科结果数据采集工具）和生活质量（儿科生活质量量表）也进行了评估。测量了纵向的年龄和性别匹配 z 分数和受损比例，并比较了组间差异。
从 150 名参与者中获得了同意和数据（平均年龄=5.1 岁[SD=1.7]，48.7%为女性）。在完成评估的参与者中，81.8%在 T1 时有 CIPN（74.5%为运动性，34.1%为感觉性）。当检查 PT/OT 结果的严重程度时，只有手握力（P<.001）和行走效率（P=.02）从 T1-T4 改善，只有背屈运动范围（46.7%对 14.7%；P=.008）和手握力（22.2%对 37.1%；P=.03）在长春新碱和地塞米松每 4 周与长春新碱和地塞米松 12 周时在 T4 时有所不同。代理报告的结果从 T1 到 T4 有所改善（P<.001），而且大多数结果在组间没有差异。
CIPN 在 B-ALL 治疗早期很常见，至少在治疗后 12 个月仍存在。尽管长春新碱的频率降低，但大多数结果在治疗组之间没有差异。即使减少长春新碱的频率，患有 B-ALL 的儿童也应监测 CIPN。
