Akut Lenfoblastik Lösemili Çocuklarda Vinkristin Nöropatisinin Değerlendirilmesi
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Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Vinkristin ilişkili nöropati (VİN), vinkristinin en sık görülen ve doz kısıtlamayı
gerektiren yan etkisidir. Yaşam kalitesini etkilediği gibi, tedavi gecikmesi ve vinkristin
tedavisinin kesilmesine yol açmaktadır. Akut lenfoblastik lösemide (ALL) sağkalım
oranlarının artmasıyla VİN’in klinik önemi artmakta olup; risk belirleyicileri, önleme ve
tedavi seçenekleri, aydınlatılması gereken önemli noktalar halini almıştır. Bu çalışma ile,
kliniğimizde tedavi gören akut lenfoblastik lösemi tanılı hastaların dosya kayıtları, VİN
açısından değerlendirilerek literatüre katkı sağlamak amaçlanmıştır.
Hastalar ve Yöntemler: Çalışmada Ocak 2010-Aralık 2020 tarihleri arasında Necmettin
Erbakan Üniversitesi Meram Tıp Fakültesi Çocuk Hematoloji ve Onkoloji Bilim Dalında
takip edilen ALL tanılı 282 hastanın dosya kayıtları geriye dönük olarak incelendi. Klinik
ve/veya elektrofizyolojik çalışma ile VİN tanısı alan 64 hasta çalışmaya dahil edildi. Aynı
hasta grubu içerisinden vinkristin nöropatisi gelişmeyen hastalardan kontrol grubu
belirlendi. Hastaların demografik özellikleri, klinik bulguları, laboratuvar değerleri,
elektromiyografi sonuçları, aldıkları vinkristin tedavisine ait parametreler, vinkristin
nöropatisi tedavisi ve tedaviye yanıtları incelendi. Nöropati şiddeti Ulusal Kanser
Enstitüsünün yaygın görülen yan etkiler için ortak terminoloji ölçeğine (CTCAE) göre
derecelendirildi. İstatistiksel analizler için SPSS programı kullanıldı ve p<0,05 olması
anlamlı kabul edildi.
v
Bulgular: Çalışmamızda VİN sıklığı %22,7 (n=64) olarak bulundu. VİN gelişen hastaların
%51,6’sı kız, %48,4’ü erkek olup; yaş ortalaması 7,42±4,86 idi. Hasta ve kontrol grubu
arasında yaş, kilo, boy, vücut kitle indeksi, immünolojik tanı, risk grubu ve tanı anı lökosit
sayısı açısından anlamlı fark saptanmadı. Hasta grubunda kontrol grubuna göre, ALL tanısı
anında genetik mutasyon saptanma oranı anlamlı olarak yüksek bulundu (p<0,05).
Hastalarda görülen en sık semptom yürüme güçlüğü; en sık gözlenen fizik muayene
bulgusu alt ekstremitelerde derin tendon reflekslerinin azalmasıydı. Hastaların %53,1’inin
elektromyografi (EMG) sonucu normal sonuçlandı. En sık saptanan patolojik EMG
bulgusu alt ekstremitelerde mikst tip polinöropatiydi (%23,4). Hasta grubunda VİN’in,
ortalama 4,45±2,77 doz vinkristin sonrası ve ortalama 6,68±4,15 mg/m
2
vinkristin
dozundan sonra geliştiği saptandı. Nöropati tedavisinde en fazla tercih edilen tedavilerin
gabapentin (%37,5) ve piridoksin-pridostigmin (%21,9) olduğu görüldü. Nöropati süreleri
ve verilen nöropati tedavileri arasında anlamlı fark saptanmadı. VİN gelişen hastaların
%9,4’ünde santral nöropati, %90,6’sında periferik nöropati görüldü. Santral ve periferik
nöropati gelişen hastalar arasında, değerlendirilen klinik ve laboratuvar özellikler açısından
anlamlı fark saptanmadı. VİN gelişen hastalar ve kontrol grubu arasında mortalite
açısından anlamlı bir fark görülmedi.
Sonuç: VİN, ALL tanılı çocuklarda hayat kalitesini etkileyen önemli bir yan etkidir.
Nöropati gelişen hastalarda klinik/elektrofizyolojik tanı koyulduktan sonra, klinik bazında
tercih edilen nöropati tedavisi başlanmalıdır. VİN’in öngörülebilmesi ve önlenmesi
amacıyla, genel kabul görmüş klinik ve laboratuvar risk faktörlerinin olmaması genetik
temelli çalışmalara ihtiyaç duyulduğunu düşündürmektedir. Böylelikle, tanımlanan risk
faktörleri sayesinde VCR tedavisi kişiselleştirilip VİN’in önlenmesi sağlanacaktır.
Objective: Vincristine-induced neuropathy (VIN) is the most common and dose-limiting adverse effect of vincristine. It does not only affect the quality of life, but also causes treatment delay and discontinuation of vincristine treatment. Clinical importance of VIN is getting increased with increasing survival rate of acute lymphoblastic leukemia (ALL), which has made the risk factors, as well as prevention and treatment options important points to consider. It was aimed with this study to contribute to the literature by evaluating medical records of patients who were diagnosed with acute lymphoblastic leukemia and being treated in our clinic in regard to VIN. Patients and Methods: In this study, medical records of 282 patients diagnosed with ALL who were followed-up in Necmettin Erbakan University, Meram Faculty of Medicine, Division of Pediatric Hematology and Oncology between January 2010 and December 2020 were examined retrospectively. Sixty-four patients who were clinically and/or electrophysiologically diagnosed with VIN were included in the study. A control group was comprised of patients from the same group who did not develop VIN. Patients’ demographic characteristics, clinical features, laboratory results, electromyography results, parameters regarding vincristine treatment, treatment for VIN and response to treatment were evaluated. Severity of neuropathy was graded in accordance with Common Terminology Criteria for Common Adverse Effects (CTCAE) of National Cancer Institute. vii For statistical analyses, SPSS package program was used and a p<0.05 was considered significant. Results: In our study, incidence of VIN was found to be 22.7% (n=64). Of the patients who developed VIN; 51.6% were female and 48.4% were male, with a mean age of 7.42±4.86. No statistically significant difference was determined between the patient and control groups in terms of age, weight, height, body mass index, immunological diagnosis, risk group and admission leukocyte count. Rate of detecting a genetic mutation at the time of diagnosis of ALL was found to be higher in the patient group compared to the control group (p<0.05). The most common symptom in the patients was gait disturbance, and the most common physical examination finding was diminished deep tendon reflexes in lower extremities. Of the patients; 53.1% had a normal electromyography (EMG). The most common pathological EMG finding was mixed-type polyneuropathy in lower extremities (23.4%). In the patient group, VIN was found to develop after a mean dose of 4.45±2.77 doses and after a mean vincristine dose of 6.68±4.15 mg/m 2 . The most common treatments preferred were found to be gabapentin (37.5%) and pyridoxine-pyridostigmine (21.9%). No significant difference was determined between duration of neuropathy and duration of treatment for neuropathy. Of the patients who developed VIN; 9.4% had central neuropathy and 90.6% had peripheral neuropathy. No significant difference was determined between the patients who developed central and peripheral neuropathy in terms of clinical and laboratory features evaluated. No difference was observed between the patients who developed VIN and the control group in terms of mortality. Conclusion: VIN is a significant adverse effect influencing quality of life in children diagnosed with ALL. Following clinical/electrophysiological diagnosis in patients who develop neuropathy, the preferred treatment for neuropathy should be initiated based upon clinical status. Lack of generally accepted clinical and laboratory risk factors for prediction and prevention of VIN suggests need for genetic studies. Thusly, vincristine treatment can be individualized and VIN can be prevented with defined risk factors.
Objective: Vincristine-induced neuropathy (VIN) is the most common and dose-limiting adverse effect of vincristine. It does not only affect the quality of life, but also causes treatment delay and discontinuation of vincristine treatment. Clinical importance of VIN is getting increased with increasing survival rate of acute lymphoblastic leukemia (ALL), which has made the risk factors, as well as prevention and treatment options important points to consider. It was aimed with this study to contribute to the literature by evaluating medical records of patients who were diagnosed with acute lymphoblastic leukemia and being treated in our clinic in regard to VIN. Patients and Methods: In this study, medical records of 282 patients diagnosed with ALL who were followed-up in Necmettin Erbakan University, Meram Faculty of Medicine, Division of Pediatric Hematology and Oncology between January 2010 and December 2020 were examined retrospectively. Sixty-four patients who were clinically and/or electrophysiologically diagnosed with VIN were included in the study. A control group was comprised of patients from the same group who did not develop VIN. Patients’ demographic characteristics, clinical features, laboratory results, electromyography results, parameters regarding vincristine treatment, treatment for VIN and response to treatment were evaluated. Severity of neuropathy was graded in accordance with Common Terminology Criteria for Common Adverse Effects (CTCAE) of National Cancer Institute. vii For statistical analyses, SPSS package program was used and a p<0.05 was considered significant. Results: In our study, incidence of VIN was found to be 22.7% (n=64). Of the patients who developed VIN; 51.6% were female and 48.4% were male, with a mean age of 7.42±4.86. No statistically significant difference was determined between the patient and control groups in terms of age, weight, height, body mass index, immunological diagnosis, risk group and admission leukocyte count. Rate of detecting a genetic mutation at the time of diagnosis of ALL was found to be higher in the patient group compared to the control group (p<0.05). The most common symptom in the patients was gait disturbance, and the most common physical examination finding was diminished deep tendon reflexes in lower extremities. Of the patients; 53.1% had a normal electromyography (EMG). The most common pathological EMG finding was mixed-type polyneuropathy in lower extremities (23.4%). In the patient group, VIN was found to develop after a mean dose of 4.45±2.77 doses and after a mean vincristine dose of 6.68±4.15 mg/m 2 . The most common treatments preferred were found to be gabapentin (37.5%) and pyridoxine-pyridostigmine (21.9%). No significant difference was determined between duration of neuropathy and duration of treatment for neuropathy. Of the patients who developed VIN; 9.4% had central neuropathy and 90.6% had peripheral neuropathy. No significant difference was determined between the patients who developed central and peripheral neuropathy in terms of clinical and laboratory features evaluated. No difference was observed between the patients who developed VIN and the control group in terms of mortality. Conclusion: VIN is a significant adverse effect influencing quality of life in children diagnosed with ALL. Following clinical/electrophysiological diagnosis in patients who develop neuropathy, the preferred treatment for neuropathy should be initiated based upon clinical status. Lack of generally accepted clinical and laboratory risk factors for prediction and prevention of VIN suggests need for genetic studies. Thusly, vincristine treatment can be individualized and VIN can be prevented with defined risk factors.
Açıklama
Anahtar Kelimeler
Akut lenfoblastik lösemi, Vinkristin nöropatisi, Çocuk, Acute lymphoblastic leukemia, Child, Vincristine-induced Neuropathy
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Camızcı, H. B. (2022). Akut Lenfoblastik Lösemili Çocuklarda Vinkristin Nöropatisinin Değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Konya.
