Small-fiber neuropathy and pain sensitization in survivors of pediatric acute lymphoblastic leukemia
- 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.
Author: | S. Lieber, Markus R. BlankenburgORCiD, K. Apel, Gerrit HirschfeldORCiD, Pablo Hernáiz Driever, T. Reindl |
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Title (English): | Small-fiber neuropathy and pain sensitization in survivors of pediatric acute lymphoblastic leukemia |
DOI: | https://doi.org/10.1016/j.ejpn.2017.12.019 |
ISSN: | 1532-2130 |
ISSN: | 1090-3798 |
Parent Title (English): | European Journal of Paediatric Neurology |
Document Type: | Article |
Language: | English |
Year of Completion: | 2018 |
electronic ID: | Zur Anzeige in scinos |
Release Date: | 2021/08/04 |
Volume: | 22 |
Issue: | 3 |
First Page: | 457 |
Last Page: | 469 |
Note: | Zugriff im Hochschulnetz |
Faculties: | Fakultät WiSo |
DDC classes: | 600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin, Gesundheit |
Review Status: | Veröffentlichte Fassung/Verlagsversion |