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Glutamine for the treatment of vincristine-induced neuropathy in children and adolescents with cancer

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Abstract

Background

Vincristine is an integral treatment component of many childhood tumors with potentially dose-limiting sensory and/or motor neuropathy. Results from a pilot study on the incidence of vincristine-induced peripheral neuropathy (VIPN) as well as the efficacy and safety of glutamine in reducing signs and symptoms of VIPN in children with cancer are presented.

Methods

Fifty-six patients between the ages of 5–21 with newly diagnosed leukemia, lymphoma, extracranial solid tumor or medulloblastoma and expected to receive a minimum cumulative dose of 6 mg/m2 of vincristine over a 30-week period were eligible. Patients’ neurological functioning was monitored every 3 weeks using clinical history, exam, and assessment of motor functioning. Upon identification of neuropathy, patients were randomized to either glutamine (6 g/m2 per dose twice daily, maximum 10 g/dose) or placebo for a 3-week period followed by 3-week wash out period (Time 3).

Results

Forty-nine patients were fully evaluable and 100 % developed neuropathy per study definitions. No significant differences in demographics or side effects were noted between the randomized groups. The distribution of sensory neuropathy scores between the two groups was statistically significant after the intervention (p = 0.022). Children receiving glutamine also rated their quality of life (QoL) as 8.42 points higher on the PedsQL total score than those receiving placebo (p = 0.031).

Conclusions

Glutamine supplementation is well tolerated and associated with improvements in sensory function and self-reported overall quality of life. Future studies are warranted to confirm the efficacy of glutamine for the treatment of vincristine-related sensory neuropathy in pediatric cancer patients.

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Acknowledgments

The authors would like to thank the families, nurses, and research staff who participated in this trial. We would like to recognize Gabrielle’s Angel Foundation for Cancer Research and the Tamarind Foundation for supporting this research.

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Authors and Affiliations

  1. Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA

    Stephen Sands, Elena J. Ladas, Kara M. Kelly, Michael Weiner, Deborah Hughes Ndao, Amie Dave & Julia Glade Bender

  2. Institute of Human Nutrition, Columbia University Medical Center, 630 West 169th Street, New York, NY, 10032, USA

    Elena J. Ladas

  3. Organization and Leadership, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA

    Meiko Lin

  4. Medical Oncology, Weill Cornell Breast Center, 425 East 61st Street, New York, NY, 10065, USA

    Linda T. Vahdat

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  1. Stephen Sands
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Correspondence to Stephen Sands.

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Sands, S., Ladas, E.J., Kelly, K.M. et al. Glutamine for the treatment of vincristine-induced neuropathy in children and adolescents with cancer. Support Care Cancer 25, 701–708 (2017). https://doi.org/10.1007/s00520-016-3441-6

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  • DOI: https://doi.org/10.1007/s00520-016-3441-6

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