Characteristics of Peripheral Polyneuropathy after Chemotherapy in Pediatric Acute Lymphoblastic Leukemia / 임상소아혈액종양

ABSTRACT

BACKGROUND: Vincristine is an antimitotic agent used for treatment of leukemia, lymphomas, and cancers. Its main side effect is a dose-related, length-dependent axonal neuropathy.METHODS: We performed electrodiagnostic examinations in 18 children who had been treated with vincristine and who presented with the clinical picture of a peripheral neuropathy.RESULTS: The mean cumulative dose of vincristine was 37.7±26.5 mg/m². Electrodiagnostic examination showed an axonal neuropathy with a length-dependent pattern. All patients showed motor nerve abnormalities and sensory nerve abnormalities were observed in 13 patients (72.2%). The number of affected nerves was 2.67±1.1 (mean±SD) of four motor nerves and 1.5±1.4 of four sensory nerves. The mean reduction of the compound muscle action potential amplitude was 70.9±42.2% in the median nerve and 23.7±20.8% in the peroneal nerve compared to normal value. However, the mean change in the sensory nerve action potential amplitude was 139.9±78.5% in the median nerve and 246.9±169.7% in the superficial peroneal nerve. There was statistically significant difference between amplitude reduction of the compound muscle action potential and sensory nerve action potential.CONCLUSION: The quantitative analysis of electrophysiological motor predominance described differs from the mainly sensory neuropathy reported in adults. Incomplete myelination in motor nerve due to young age may have resulted in greater sensitivity of some nerves to neurotoxic agents.