Reducing vincristine frequency to every 12 weeks reduced dorsiflexion range of motion impairment compared to every 4 weeks (14.7% vs 46.7%), but most other neuropathy outcomes did not differ.
RCT (n=150)
2x2 factorial design
Yes
Does reduced frequency of vincristine and dexamethasone reduce chemotherapy-induced peripheral neuropathy in children with B-acute lymphoblastic leukemia?
Reducing the frequency of vincristine and dexamethasone during maintenance therapy for childhood B-ALL does not significantly reduce the persistence of chemotherapy-induced peripheral neuropathy.
Absolute Event Rate: 14.7% vs 46.7%
p-value: p=0.008
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Rodwin et al. (Fri,) conducted a rct in Childhood B-Acute Lymphoblastic Leukemia (n=150). Vincristine and dexamethasone reduction vs. Every 4 weeks was evaluated on Dorsiflexion range of motion impairment at 12 months posttherapy (p=0.008). Reducing vincristine frequency to every 12 weeks reduced dorsiflexion range of motion impairment compared to every 4 weeks (14.7% vs 46.7%), but most other neuropathy outcomes did not differ.