Pyridoxine plus pyridostigmine has been found to be beneficial for chemotherapy-induced neuropathy in pediatric patients with acute lymphoblastic leukemia (ALL), according to research in Neurological Sciences.

Vincristine is a key component of chemotherapy for children with ALL. However, it is also associated with peripheral neuropathy. Symptoms of vincristine-induced peripheral neuropathy (VIPN) commonly appear 2 to 19 weeks after a patient starts treatment with vincristine.

Although symptoms of acute neurotoxicity are often reversible, resolution of symptoms may take several months or years after treatment ends. Chronic neurotoxicity is irreversible and leads to reduced quality of life years after treatment.

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In this study, the authors prospectively evaluated the clinical features of 23 pediatric patients with ALL who developed VIPN. The authors used World Health Organization (WHO) neurotoxicity scores and National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) scores to identify VIPN at diagnosis.

The authors sought to determine the effectiveness of pyridoxine (vitamin B6) plus pyridostigmine therapy for VIPN. They assessed neuropathy at diagnosis, after 1 month of therapy, and after 3 months of study therapy. The patients were classified as being at standard risk, intermediate risk, or high risk of developing VIPN.

Out of the 23 patients studied, 82.6% had neuropathy at induction of pyridoxine plus pyridostigmine. At VIPN diagnosis, patients experienced deep tendon reflex alterations, depression of Achilles reflex, loss of muscle tone, muscular weakness, and gait disorder. WHO scoring and NCI CTCAE scores all improved significantly at 1 month and 3 months of therapy without discontinuing vincristine. Fewer patients experienced grade 1 through 4 sensory and motor symptoms at 1 and 3 months.

No side effects were observed with the pyridoxine plus pyridostigmine therapy, which led the authors to conclude this may be an effective treatment for VIPN.

Although the study was limited by the small sample size and lack of a control group, the authors propose that pyridoxine plus pyridostigmine is beneficial for VIPN symptoms in children with ALL.


Aydin Köker S, Gözmen S, Demirağ B, et al. Effect of pyridoxine plus pyridostigmine treatment on vincristine-induced peripheral neuropathy in pediatric patients with acute lymphoblastic leukemia: a single-center experience. Neurol Sci. Published online January 13, 2021. doi:10.1007/s10072-020-04970-w