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. 2011 Dec 15;57(7):1147-53.
doi: 10.1002/pbc.23039. Epub 2011 Feb 11.

Neuropathic pain during treatment for childhood acute lymphoblastic leukemia

Doralina L Anghelescu  1 , Lane G Faughnan, Sima Jeha, Mary V Relling, Pamela S Hinds, John T Sandlund, Cheng Cheng, Deqing Pei, Gisele Hankins, Jennifer L Pauley, Ching-Hon Pui
Affiliations

Neuropathic pain during treatment for childhood acute lymphoblastic leukemia

Doralina L Anghelescu et al. Pediatr Blood Cancer. .

Abstract

Background: Improved cure rates for childhood acute lymphoblastic leukemia (ALL) over the past 2 decades have allowed greater attention to patients' quality of life. Neuropathic pain (NP) is an unpleasant side effect of chemotherapeutic agents for leukemia, especially vincristine.

Procedure: We retrospectively reviewed the records of 498 patients treated on a single protocol for ALL to investigate the risk factors, the incidence, and the use of therapeutic and prophylactic gabapentin treatment for NP.

Results: White non-Hispanic race was the only patient variable predictive of NP. One hundred and seventy-four of 498 patients (34.9%) experienced 207 episodes of NP; 16% (28 of 174) patients experienced at least one recurrence of pain after the initial episode. No statistical significance was found in the relation between the severity (grade) of the NP episode and the cumulative dose of vincristine (P = 0.45) or the vincristine dose that immediately preceded the diagnosis (1.5 mg/m(2) versus 2.0 mg/m(2) [correction made here after initial online publication], P = 0.59). Of 180 episodes with treatment data, 62.2% (112) and 37.8% (68) were treated with gabapentin or opioids, respectively. The selection of treatment with gabapentin or opioids was not influenced by the pain intensity score at the time of diagnosis of NP (P = 0.91). The mean gabapentin dose used for 112 episodes was 15.5 mg/kg/day (SD 7.9). We found no evidence that gabapentin prevented recurrence of NP.

Conclusions: Our results highlight the need for prospective randomized studies to elucidate the value of gabapentin regimen for prevention or treatment of vincristine-related pain during treatment of childhood leukemia.

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Conflict of interest statement

Conflict of Interest Statement

The authors of this manuscript have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Cumulative Incidence of Vincristine-Related Neuropathic Pain in Total Therapy XV.
Figure 2
Figure 2
Flowchart of VCR-Related Neuropathic Pain Episodes and Treatment Outcomes. Key: NP: neuropathic pain; VCR: vincristine
See this image and copyright information in PMC

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