Vincristine: Severe Neurotoxicities in Acute Lymphoblastic Leukemia

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J Pediatr Hematol Oncol. 2008 Jul;30(7):519-521.

Severe Neurotoxicities in a Case of Charcot-Marie-Tooth Disease Type

2 Caused by Vincristine for Acute Lymphoblastic Leukemia.

Nishikawa T, Kawakami K, Kumamoto T, Tonooka S, Abe A, Hayasaka K,

Okamoto Y, Kawano Y.

Department of Pediatrics, Kagoshima City Hospital double

daggerDepartment of Pediatrics, Kagoshima University Graduate School

of Medical and Dental Sciences, Kagoshima daggerFaculty of Medicine,

Department of Pediatrics, University of Yamagata, Yamagata, Japan.

We report a 13-year-old male patient with Charcot-Marie-Tooth disease

(CMT) type 2 who developed severe neuropathy because of vincristine

(VCR) for his acute lymphoblastic leukemia. A clumsy gait, muscle

weakness in his fingers, and inverted champagne bottlelike muscle in

the lower limbs were noticed after remission induction treatment for

acute lymphoblastic leukemia, which included VCR at a total dose of 8

mg/m.

An electrophysiologic study showed an almost normal median motor

nerve conduction velocity (approximately 50 m/s), markedly reduced M-

wave amplitude and sensory disturbance. He was diagnosed as CMT type

2 based on his symptoms and electrophysiologic findings. His symptoms

gradually worsened, and even after VCR was discontinued, he could not

walk alone for 7 months.

VCR has previously been considered to be relatively safe in CMT type

2, however, some patients with CMT type 2 might show severe

neurologic toxicities, as seen in patients with CMT type 1.