Evolution of neuropathy and myopathy during intensive vincristine/corticosteroid
chemotherapy for non-Hodgkin's lymphoma.
Author(s): DeAngelis LM(1), Gnecco C, Taylor L, Warrell RP Jr.
Affiliation(s): Author information:
(1)Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New
York 10021.
Publication date & source: 1991, Cancer. , 67(9):2241-6
Neuropathy and myopathy are common sequelae of intensive chemotherapy protocols
that contain vincristine and corticosteroids. The authors prospectively monitored
the evolution of neuropathy and myopathy during an intensive 12-week chemotherapy
program for patients with intermediate and high-grade non-Hodgkin's lymphoma. In
this study, vincristine was administered by bolus injection followed by a 3-day
continuous intravenous (IV) infusion (total dose of 2.0 mg/m2 every other week);
the maximum dose of vincristine was not arbitrarily limited. Cronassial, a
mixture of four naturally occurring gangliosides, was administered in a
randomized double-blind test to evaluate whether this agent could prevent
vincristine-induced neuropathy. High doses of dexamethasone (50 mg/d for 3 days
weekly or every other week) were also prescribed. Patients were monitored every 4
weeks with comprehensive physical and neurologic examinations and
electrophysiologic studies of peripheral nerve function. Twenty-seven patients
were fully evaluable. Weakness was a prominent adverse reaction in this study,
and all patients had moderate to severe signs and symptoms of neuropathy and
myopathy. Cronassial (100 mg) administered by intramuscular (IM) injection daily
provided no protection against the development of neuropathic symptoms.
Vincristine typically impaired fine-motor coordination initially, whereas
corticosteroids were associated with delayed development of proximal muscle
weakness. Results of electrodiagnostic studies did not add to the clinical
examination results. The authors conclude that symptomatic weakness due to
neuropathy or myopathy appears in a predictable manner during intensive
vincristine/corticosteroid-based treatment protocols. Simple clinical tests can
be used to rapidly distinguish between toxic effects due either to vincristine or
corticosteroids, and routine implementation of these tests can prevent
inappropriate dose attenuation of these agents.
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