Incidence of vincristine-induced neuropathy does not appear to be associated with nutritional deficiencies, according to research published in Pediatric Hematology and Oncology.

Vincristine, a vinca alkaloid chemotherapy drug, is commonly used in the treatment of childhood acute lymphoblastic leukemia (ALL) but can lead to chemotherapy-induced peripheral neuropathy, an important dose-limiting toxicity. However, little research has been conducted in patients with possible concomitant nutritional deficiencies.

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Therefore, researchers conducted a prospective observational study over a period of 2 years at a children’s hospital in India. They evaluated 30 children with newly diagnosed ALL, 28 (93.3%) of whom had B-cell ALL and 2 (6.7%) of whom had T-cell ALL. Vitamin B12, folate, and serum ferritin levels were measured for all patients.

Over 4 weeks of observation, clinical peripheral neuropathy  developed in 12 patients. Autonomic nervous system involvement was the most common, but involvement of the sensory and motor systems occurred as well. Electrophysiologic testing found that 15 patients (50%) had neuropathy.

Undernutrition, defined using criteria from the World Health Organization, was identified in 14 patients (46.7%). No difference was found in incidence of vincristine-induced neuropathy between patients with undernutrition (7 patients) and patients without undernutrition (8 patients). Additionally, the researchers found no correlation between presence of undernutrition and development of neuropathy (P =1.0). Levels of vitamin B12, folate, and serum ferritin were similar in children with and without neuropathy.

The researchers concluded that although optimal nerve function is dependent on a constant supply of macronutrients and micronutrients, nutritional deficiencies may not influence development of neuropathy in Indian children with ALL. However, they acknowledged that their study had some limitations, such as the inability to measure expression of CYP3A5 (an enzyme responsible for vincristine metabolism) and serum albumin and the use of ferritin to assess iron deficiency. They noted that further research is warranted to evaluate the role of micronutrient deficiencies in the development of vincristine-induced peripheral neuropathy in childhood ALL.

Reference

1.     Dudeja S, Gupta S, Sharma S, et al. Incidence of vincristine induced neurotoxicity in children with acute lymphoblastic leukemia and its correlation with nutritional deficiencies [published online September 13, 2019]. Pediatr Hematol Oncol.