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Measuring Vincristine-Induced Peripheral Neuropathy in Children With Acute Lymphoblastic Leukemia

Smith, Ellen M. Lavoie PhD, APN-BC, AOCN; Li, Lang PhD; Hutchinson, Raymond J. MD; Ho, Richard MD; Burnette, W. Bryan MD, MS; Wells, Elizabeth MD, MHS; Bridges, Celia BA, BSN, RN; Renbarger, Jamie MD, MS

doi: 10.1097/NCC.0b013e318299ad23
Articles: Online Only

Background: Vincristine-induced peripheral neuropathy (VIPN) is difficult to quantify in children.

Objective: The study objective was to examine the reliability, validity, and clinical feasibility of several VIPN measures for use in children with acute lymphoblastic leukemia.

Interventions/Methods: Children (n = 65) aged 1 to 18 years receiving vincristine at 4 academic centers participated in the study. Baseline and pre–vincristine administration VIPN assessments were obtained using the Total Neuropathy Score–Pediatric Vincristine (TNS©-PV), the National Cancer Institute Common Terminology Criteria for Adverse Events, the Balis grading scale, and the FACES Pain Scale. The TNS-PV scores (n = 806) were obtained over 15 weeks. Blood was obtained at several time points to quantify pharmacokinetic parameters.

Results: Cronbach’s α for a reduced TNS-PV scale was .84. The TNS-PV scores correlated with cumulative vincristine dosage (r = 0.53, P = 0.01), pharmacokinetic parameters (r = 0.41, P = 0.05), and grading scale scores (r range = 0.46–0.52, P = .01). FACES scores correlated with the TNS-PV neuropathic pain item (r = 0.48; P = .01) and were attainable in all ages. A 2-item V-Rex score (vibration and reflex items) was the most responsive to change (effect size = 0.65, P < 0.001). The TNS-PV scores were attainable in 95% of children 6 years or older.

Conclusions: The TNS-PV is reliable and valid for measuring VIPN. It is sensitive to change over time (15 weeks) and feasible for use in children 6 years or older.

Implications for Practice: The TNS-PV may be a useful tool for assessing vincristine toxicity in children with acute lymphoblastic leukemia.

Author Affiliations: School of Nursing, University of Michigan, Ann Arbor (Dr Smith and Ms Bridges); School of Medicine/Riley Hospital for Children, Indiana University, Indianapolis (Drs Renbarger and Li); School of Medicine, University of Michigan, Ann Arbor (Dr Hutchinson); Vanderbilt University/Monroe Carell Jr Children’s Hospital, Nashville, Tennessee (Drs Ho and Burnette); Department of Neurology and the Brain Tumor Institute, George Washington University/Children’s National Medical Center, Washington, DC (Dr Wells).

Funding for this work was provided by NCI RO1 PAR-08-248-0132428 (to Drs Smith, Lang, Hutchinson, Ho, Burnette, and Wells; Ms Bridges; and Dr Renbarger) and 3UL 1RR025761-02S5, CA146882-01 (to Drs Smith, Li, and Renbarger).

The authors have no conflicts of interest to disclose.

Correspondence: Ellen M. Lavoie Smith, PhD, APN-BC, AOCN, School of Nursing, University of Michigan, 400 N Ingalls, Ann Arbor, MI 48109 (ellenls@umich.edu).

Accepted for publication April 30, 2013.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins