TY  - JOUR
U1  - Zeitschriftenartikel, wissenschaftlich - begutachtet (reviewed)
A1  - Lieber, S.
A1  - Blankenburg, Markus R.
A1  - Apel, K.
A1  - Hirschfeld, Gerrit
A1  - Hernáiz Driever, Pablo
A1  - Reindl, T.
T1  - Small-fiber neuropathy and pain sensitization in survivors of pediatric acute lymphoblastic leukemia
JF  - European Journal of Paediatric Neurology
N2  - Background:
Chemotherapy-induced Peripheral Neuropathy (CIPN) of large-fibers affects up to 20% of survivors of pediatric acute lymphoblastic leukemia (ALL). We aimed to describe small-fiber toxicity and pain sensitization in this group.

Methods:
In a cross-sectional, bicentric study we assessed 46 survivors of pediatric ALL (Mean age: 5.7 ± 3.5 years at diagnosis, median 2.5 years after therapy; males: 28). Inclusion criteria: ≥6 years of age, ≥3 months after last administration of Vincristine, and cumulative dose of Vincristine 12 mg/m2. We used a reduced version of the Pediatric-modified Total Neuropathy Score (Ped-mTNS) as bedside test and Quantitative Sensory Testing (QST) for assessment of small- and large-fiber neuropathy as well as pain sensitization. We employed Nerve Conduction Studies (NCS) as the most accurate tool for detecting large-fiber neuropathy.

Results:
Fifteen survivors (33%) had abnormal rPed-mTNS values (≥4 points) and 5 survivors (11%) reported pain. In QST, the survivor group showed significant (p < 0.001) inferior large-fiber function and pain sensitization when compared to healthy matched peers. We identified deficits of vibration in 33 (72%) and tactile hypoesthesia in 29 (63%), hyperalgesia to blunt pressure in 19 (41%), increased mechanical pain sensitivity in 12 (26%) and allodynia in 16 (35%) of 46 survivors. Only 7 survivors (15%) had pathologic NCS.

Conclusion:
QST is a sensitive tool that revealed signs of large-fiber neuropathy in two thirds, small-fiber neuropathy and pain sensitization in one third of survivors. Prospective studies using QST in pediatric oncology may help to elucidate the pathophysiology of small-fiber neuropathy and pain sensitization as well as their relevance for quality of survival.
Y1  - 2018
SN  - 1532-2130
SS  - 1532-2130
SN  - 1090-3798
SS  - 1090-3798
U6  - https://doi.org/10.1016/j.ejpn.2017.12.019
DO  - https://doi.org/10.1016/j.ejpn.2017.12.019
N1  - Zugriff im Hochschulnetz
VL  - 22
IS  - 3
SP  - 457
EP  - 469
ER  -