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Cavaletti G, Forsey K, Alberti P. Toxic medications in Charcot-Marie-Tooth patients: A systematic review. J Peripher Nerv Syst 2023; 28:295-307. [PMID: 37249082 DOI: 10.1111/jns.12566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIMS Several widely used medications, with a relevant efficacy profile, are toxic to the peripheral nervous system and an even larger number of agents are suspected to be neurotoxic. There are concerns about the use of these drugs in patients with Charcot-Marie-Tooth disease (CMT), a hereditary motor and sensory neuropathy. This review provides evidence-based updated recommendations on this clinically relevant topic. METHODS A systematic review of the available studies/reports written in English was performed from July to September 2022 including in the search string all reported putative neurotoxic drugs. RESULTS The results of our systematic review provide evidence-based support for the statement that use of vincristine, and possibly paclitaxel, can occasionally induce an atypical, and more severe, course of drug-related peripheral neurotoxicity in CMT patients. It is therefore reasonable to recommend caution in the use of these compounds in CMT patients. However, no convincing evidence for a similar recommendation could be found for all other drugs. INTERPRETATION It is important that patients with CMT are not denied effective treatments that may prolong life expectancy for cancer or improve their health status if affected by non-oncological diseases. Accurate monitoring of peripheral nerve function in CMT patients treated with any neurotoxic agent remains mandatory to detect the earliest signs of neuropathy worsening and atypical clinical courses. Neurologists monitoring CMT patients as part of their normal care package or for natural history studies should keep detailed records of exposures to neurotoxic medications and support reporting of accelerated neuropathy progression if observed.
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Affiliation(s)
- Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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2
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Hess PP, Ventura Ferreira MS, Rolles B, Kirschner M, Holtbernd F, Tometten M, Brümmendorf TH, Beier F. Effective treatment of advanced Hodgkin lymphoma with a modified BEACOPP regimen for a patient with demyelinating hereditary motor and sensory neuropathy type 1 (HMSN1). Clin Case Rep 2022; 10:e05766. [PMID: 35540715 PMCID: PMC9069391 DOI: 10.1002/ccr3.5766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022] Open
Abstract
Treatment for Hodgkin lymphoma (HL) in adults comprises substantial risk of chemotherapy‐induced peripheral neurotoxicity. Here, we describe the case of patient with Charcot–Marie–Tooth disease or HSMN1 and advanced Hodgkin lymphoma undergoing treatment with modified BEACOPP achieving complete remission without major aggravation of neurological symptoms.
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Affiliation(s)
- Patrick P. Hess
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation RWTH Aachen University Aachen Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) Aachen Germany
| | - Monica S. Ventura Ferreira
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation RWTH Aachen University Aachen Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) Aachen Germany
| | - Benjamin Rolles
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation RWTH Aachen University Aachen Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) Aachen Germany
| | - Martin Kirschner
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation RWTH Aachen University Aachen Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) Aachen Germany
| | - Florian Holtbernd
- Department of Neurology Medical Faculty RWTH Aachen University Aachen Germany
| | - Mareike Tometten
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation RWTH Aachen University Aachen Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) Aachen Germany
| | - Tim H. Brümmendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation RWTH Aachen University Aachen Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) Aachen Germany
| | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation RWTH Aachen University Aachen Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) Aachen Germany
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3
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Egan-Sherry D, Bhuta R, Cole PD, Gennarini LM, Kahn JM, Sulis ML, DeNardo BD, Welch JJG. Severe Vincristine-related Neurotoxicity in 5 Patients With Pediatric Acute Lymphoblastic Leukemia Requiring Discontinuation of Vincristine: A Description of Long-term Outcome. J Pediatr Hematol Oncol 2021; 43:e997-e999. [PMID: 34001785 DOI: 10.1097/mph.0000000000002114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
Vincristine, a key agent in the treatment of many pediatric malignancies, causes sensory, motor and autonomic neuropathy. We report the clinical courses of 5 patients who required cessation of vincristine after developing severe neurotoxicity during treatment for acute lymphoblastic leukemia. All 5 patients lost the ability to ambulate and 3 had additional severe neurotoxic side effects including vision loss and vocal cord dysfunction. Although prior literature reports poor outcomes for children in whom vincristine was discontinued during acute lymphoblastic leukemia therapy, all 5 patients described here achieved and have maintained complete continuous remission.
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Affiliation(s)
| | - Roma Bhuta
- Department of Pediatrics, Division of Hematology/Oncology, Brown University and Hasbro Children's Hospital, Providence, RI
| | - Peter D Cole
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Lisa M Gennarini
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx
| | - Justine M Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center
| | - Maria Luisa Sulis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bradley D DeNardo
- Department of Pediatrics, Division of Hematology/Oncology, Brown University and Hasbro Children's Hospital, Providence, RI
| | - Jennifer J G Welch
- Department of Pediatrics, Division of Hematology/Oncology, Brown University and Hasbro Children's Hospital, Providence, RI
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4
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Peripheral Nervous System Involvement in Non-Primary Pediatric Cancer: From Neurotoxicity to Possible Etiologies. J Clin Med 2021; 10:jcm10143016. [PMID: 34300182 PMCID: PMC8303855 DOI: 10.3390/jcm10143016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023] Open
Abstract
Peripheral neuropathy is a well described complication in children with cancer. Oncologists are generally well aware of the toxicity of the main agents, but fear the side effects of new drugs. As chemotherapeutic agents have been correlated with the activation of the immune system such as in Chemotherapy Induced Peripheral Neuropathy (CIPN), an abnormal response can lead to Autoimmune Peripheral Neuropathy (APN). Although less frequent but more severe, Radiation Induced Peripheral Neuropathy may be related to irreversible peripheral nervous system (PNS). Pediatric cancer patients also have a higher risk of entering a Pediatric Intensive Care Unit for complications related to therapy and disease. Injury to peripheral nerves is cumulative, and frequently, the additional stress of a malignancy and its therapy can unmask a subclinical neuropathy. Emerging risk factors for CIPN include treatment factors such as dose, duration and concurrent medication along with patient factors, namely age and inherited susceptibilities. The recent identification of individual genetic variations has advanced the understanding of physiopathological mechanisms and may direct future treatment approaches. More research is needed on pharmacological agents for the prevention or treatment of the condition as well as rehabilitation interventions, in order to allow for the simultaneous delivery of optimal cancer therapy and the mitigation of toxicity associated with pain and functional impairment. The aim of this paper is to review literature data regarding PNS complications in non-primary pediatric cancer.
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5
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Lynch DR, Schadt K, Kichula E, McCormack S, Lin KY. Friedreich Ataxia: Multidisciplinary Clinical Care. J Multidiscip Healthc 2021; 14:1645-1658. [PMID: 34234452 PMCID: PMC8253929 DOI: 10.2147/jmdh.s292945] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022] Open
Abstract
Friedreich ataxia (FRDA) is a multisystem disorder affecting 1 in 50,000-100,000 person in the United States. Traditionally viewed as a neurodegenerative disease, FRDA patients also develop cardiomyopathy, scoliosis, diabetes and other manifestation. Although it usually presents in childhood, it continues throughout life, thus requiring expertise from both pediatric and adult subspecialist in order to provide optimal management. The phenotype of FRDA is unique, giving rise to specific loss of neuronal pathways, a unique form of cardiomyopathy with early hypertrophy and later fibrosis, and diabetes incorporating components of both type I and type II disease. Vision loss, hearing loss, urinary dysfunction and depression also occur in FRDA. Many agents are reaching Phase III trials; if successful, these will provide a variety of new treatments for FRDA that will require many specialists who are not familiar with FRDA to provide clinical therapy. This review provides a summary of the diverse manifestation of FRDA, existing symptomatic therapies, and approaches for integrative care for future therapy in FRDA.
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Affiliation(s)
- David R Lynch
- Division of Neurology, Departments of Pediatrics and Neurology, Children’s Hospital of Philadelphia and the Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kim Schadt
- Division of Neurology, Departments of Pediatrics and Neurology, Children’s Hospital of Philadelphia and the Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Elizabeth Kichula
- Division of Neurology, Departments of Pediatrics and Neurology, Children’s Hospital of Philadelphia and the Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Shana McCormack
- Division of Endocrinology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kimberly Y Lin
- Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia and the Perelman School of Medicine, Philadelphia, PA, 19104, USA
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6
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Vaeth S, Andersen H, Christensen R, Jensen UB. A Search for Undiagnosed Charcot-Marie-Tooth Disease Among Patients Registered with Unspecified Polyneuropathy in the Danish National Patient Registry. Clin Epidemiol 2021; 13:113-120. [PMID: 33623438 PMCID: PMC7896779 DOI: 10.2147/clep.s292676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose In a recent study based on data from the Danish National Patients Registry (DNPR), we reported the prevalence of Charcot-Marie-Tooth disease (CMT) in Denmark to be 22.5 per 100.000. This prevalence is most likely a minimum estimate, as many cases of CMT may be misdiagnosed or remain undiagnosed due to the heterogeneous nature of the disorder. The aim of this study was to investigate the possible number of undiagnosed CMT cases among patients registered with unspecified polyneuropathy (UP) diagnoses in the DNPR. Patients and Methods From the DNPR we extracted data on all patients given an UP diagnosis in the period 1977 to 2012. We selected all patients diagnosed with a primary UP diagnosis before age 40 at a department of neurology, neurophysiology, clinical genetics or pediatrics, and excluded all patients with a specified polyneuropathy diagnosis or with diagnostic codes related to alcohol and diabetes mellitus. To assess the proportion of possible CMT patients, we performed medical record review in a random sample of patients diagnosed in the Central Denmark Region. To further investigate the possible overlap between UP and CMT in the DNPR, we performed a series of searches for ICD-8 and ICD-10 codes related to CMT. Results Between 1977 and 2012, 30.903 patients were diagnosed with UP without also being diagnosed with CMT. A total of 940 patients fulfilled the selection criteria. We found that 21.5% (95% CI 13.1%–32.2%) of the cases in the random sample fulfilled our criteria for CMT. This estimate increases the prevalence of CMT in Denmark with 3.6 per 100,000 (95% CI 2.4%–5.5%). Conclusion This study illustrates how hitherto undiagnosed CMT patients may be identified in the DNPR and further reports the number of possible CMT cases. Our results support the hypothesis that the true prevalence of CMT is higher than recently reported.
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Affiliation(s)
- Signe Vaeth
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark
| | - Rikke Christensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
| | - Uffe Birk Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus N, Denmark
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7
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Rokohl AC, Skoetz N, Mor JM, Loreck N, Koch KR, Heindl LM. Intravenous chemotherapy versus intra-arterial chemotherapy for retinoblastoma. Hippokratia 2020. [DOI: 10.1002/14651858.cd013695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology; University of Cologne, Faculty of Medicine and University Hospital of Cologne; Cologne Germany
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; Faculty of Medicine and University Hospital Cologne, University of Cologne; Cologne Germany
| | - Joel M Mor
- Department of Ophthalmology; University of Cologne, Faculty of Medicine and University Hospital of Cologne; Cologne Germany
| | - Niklas Loreck
- Department of Ophthalmology; University of Cologne, Faculty of Medicine and University Hospital of Cologne; Cologne Germany
| | - Konrad R Koch
- Department of Ophthalmology; University of Cologne, Faculty of Medicine and University Hospital of Cologne; Cologne Germany
| | - Ludwig M Heindl
- Department of Ophthalmology; University of Cologne, Faculty of Medicine and University Hospital of Cologne; Cologne Germany
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8
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Ali SA, Hanks JE, Stebbins AW, Cohen ST, Hunter DA, Snyder-Warwick AK, Mackinnon SE, Kupfer RA, Hogikyan ND, Feldman EL, Brenner MJ. Comparison of Myelin-Associated Glycoprotein With Vincristine for Facial Nerve Inhibition After Bilateral Axotomy in a Transgenic Thy1-Gfp Rat Model. JAMA FACIAL PLAST SU 2019; 21:426-433. [PMID: 31219545 PMCID: PMC6587147 DOI: 10.1001/jamafacial.2019.0398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Aberrant synkinetic movement after facial nerve injury can lead to prominent facial asymmetry and resultant psychological distress. The current practices of neuroinhibition to promote greater facial symmetry are often temporary in nature and require repeated procedures. OBJECTIVE To determine whether myelin-associated glycoprotein (MAG), a specific neuroinhibitor, can prevent neuroregeneration with efficacy comparable with that of vincristine, a well-established neurotoxin. DESIGN, SETTING, AND PARTICIPANTS Rats transgenic for Thy-1 cell surface antigen-green fluorescent protein (Thy1-Gfp) were randomized into 3 groups. Each rat received bilateral crush axotomy injuries to the buccal and marginal mandibular branches of the facial nerves. The animals received intraneural injection of saline, MAG, or vincristine. MAIN OUTCOMES AND MEASURES The animals were imaged via fluorescent microscopy at weeks 1, 3, 4, and 5 after surgery. Quantitative fluorescent data were generated as mean intensities of nerve segments proximal and distal to the axotomy site. Electrophysiological analysis, via measurement of compound muscle action potentials, was performed at weeks 0, 3, 4, and 5 after surgery. RESULTS A total of 12 rats were included in the study. Administration of MAG significantly reduced fluorescent intensity of the distal nerve in comparison with the control group at week 3 (mean [SD], MAG group: 94 [11] intensity units vs control group: 130 [11] intensity units; P < .001), week 4 (MAG group: 81 [19] intensity units vs control group: 103 [9] intensity units; P = .004), and week 5 (MAG group: 76 [10] intensity units vs control group: 94 [10] intensity units; P < .001). In addition, rats treated with MAG had greater fluorescent intensity than those treated with vincristine at week 3 (mean [SD], MAG group: 94 [11] intensity units vs vincristine group: 76 [6] intensity units; P = .03), although there was no significant difference for weeks 4 and 5. At week 5, both MAG and vincristine demonstrated lower distal nerve to proximal nerve intensity ratios than the control group (control group, 0.94; vs MAG group, 0.82; P = .01; vs vincristine group; 0.77; P < .001). There was no significant difference in amplitude between the experimental groups at week 5 of electrophysiological testing. CONCLUSIONS AND RELEVANCE Lower facial asymmetry and synkinesis are common persistent concerns to patients after facial nerve injury. Using the Thy1-Gfp rat, this study demonstrates effective inhibition of neuroregeneration via intraneural application of MAG in a crush axotomy model, comparable with results with vincristine. By potentially avoiding systemic toxic effects of vincristine, MAG demonstrates potential as an inhibitor of neural regeneration for patients with synkinesis. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- S. Ahmed Ali
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - John E. Hanks
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - Aaron W. Stebbins
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
- Department of Neurology, Michigan Medicine, Ann Arbor
| | - Samantha T. Cohen
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - Daniel A. Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Alison K. Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Robbi A. Kupfer
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | - Norman D. Hogikyan
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
| | | | - Michael J. Brenner
- Department of Otolaryngology–Head & Neck Surgery, Michigan Medicine, Ann Arbor
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Bernstock JD, Cohen JL, Singh S, Schlappi CW, Fiveash JB, Johnston JM, Fequiere P, Orr BA, Li R, Friedman GK. Treatment-induced remission of medulloblastoma using a chemotherapeutic regimen devoid of vincristine in a child with Charcot-Marie-Tooth disease. ACTA ACUST UNITED AC 2019; 26:e266-e269. [PMID: 31043836 DOI: 10.3747/co.26.4491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Charcot-Marie-Tooth (cmt) disease is the most common form of inherited neuropathy. Core features include peripheral neuropathy and secondary axonal degeneration, with a noted distal predominance of limb-muscle wasting, weakness, and sensory loss. Given the significant prevalence of cmt, superimposed neoplastic disease can be encountered within this patient population. Malignancies that are treated with vincristine (a microtubule-targeting agent), even at low doses as part of standard treatment, pose a significant challenge for patients with cmt. Here, we present the case of a child with cmt who was successfully treated for medulloblastoma without vincristine, a standard drug used for treatment of that disease, to avoid the risk of severe debilitating neuropathy. This report is the first of a patient successfully treated for medulloblastoma without vincristine.
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Affiliation(s)
- J D Bernstock
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - J L Cohen
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - S Singh
- Department of Radiology, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - C W Schlappi
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - J B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - J M Johnston
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - P Fequiere
- Department of Pediatrics, Division of Neurology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - B A Orr
- Pathology Department, St. Jude Children's Research Hospital, Memphis, TN, U.S.A
| | - R Li
- Department of Pathology, Children's of Alabama, Birmingham, AL, U.S.A
| | - G K Friedman
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
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Kissoon T, Gururangan S, Sladky J. Acute neurotoxicity following vincristine due to Charcot-Marie-Tooth disease in a young child with medulloblastoma. Neurooncol Pract 2019; 6:179-184. [PMID: 31385990 DOI: 10.1093/nop/npz002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/18/2018] [Accepted: 01/09/2019] [Indexed: 01/28/2023] Open
Abstract
Vincristine (VCR), a microtubule inhibitor that arrests the cell cycle by blocking metaphase of mitosis, is unique among the vinca alkaloids for causing polyneuropathy. Patients with increased risk of VCR neurotoxicity include the elderly and those with prior history of neuropathy-prone medical conditions. Identifying such risk factors prior to the development of neurotoxicity should be a goal prior to VCR administration. Clinicians should obtain a thorough medical and family history of neuropathies in any child scheduled to receive neurotoxic medications to avoid exacerbating an underlying disorder. We report a case of a young child with newly diagnosed medulloblastoma who started treatment on a VCR-containing chemotherapy regimen following surgery and craniospinal radiation. She subsequently developed severe peripheral polyneuropathy and new enhancement of the cranial and nerve roots following a relatively low cumulative dose of VCR and was diagnosed with previously unidentified Charcot-Marie-Tooth disease (CMTD) Type 1A. This case highlights that an evaluation of risk factors should be completed prior to initiation of neurotoxic chemotherapies and advocates for testing for inherited neuropathies such as CMTD even in asymptomatic patients when hereditary neuropathy is suspected.
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Affiliation(s)
- Trisha Kissoon
- Department of Pediatrics, Hematology-Oncology, University of Florida, Gainesville.,Department of Neurosurgery, University of Florida, Gainesville
| | - Sridharan Gururangan
- Department of Pediatrics, Hematology-Oncology, University of Florida, Gainesville.,Department of Neurosurgery, University of Florida, Gainesville.,Preston A. Wells Jr. Center for Brain Tumor Therapy, University of Florida, Gainesville
| | - John Sladky
- Department of Pediatrics, Hematology-Oncology, University of Florida, Gainesville.,Department of Neurology, University of Florida, Gainesville
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11
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Jariwal R, Shoua B, Sabetian K, Natarajan P, Cobos E. Unmasking a Case of Asymptomatic Charcot-Marie-Tooth Disease (CMT1A) With Vincristine. J Investig Med High Impact Case Rep 2018; 6:2324709618758349. [PMID: 29511693 PMCID: PMC5833168 DOI: 10.1177/2324709618758349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/08/2018] [Accepted: 01/13/2018] [Indexed: 12/18/2022] Open
Abstract
Charcot-Marie-Tooth (CMT) disease is a hereditary demyelinating disease of the peripheral nervous system that results in sensory and motor dysfunction. CMT includes a spectrum of diseases with different types of mutations in the genes encoding myelin protein, resulting in a variety of dysfunctions in its life cycle. In CMT subtype 1A there is duplication mutation of peripheral myelin protein 22 gene on chromosome 17. Incomplete penetrance, gene-dosage effect, and variable expressivity can attribute to the asymptomatic nature of the disease in some subset of patients. Vincristine administration is contraindicated in patients who are alrea\dy diagnosed with CMT disease. We report a case of asymptomatic CMT disease unmasked only by the neurotoxic effects of vincristine. Genetic testing for a patient with a preexisting family background of inherited diseases before starting vincristine therapy can potentially prevent a disability.
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