329 - Peripheral Neuropathy in Pediatric Oncology Patients Receiving Vincristine and Levofloxacin Compared to Vincristine Alone

Poster Number: 329
Publication Number: 329.113

Prerna Kumar, University of Illinois College of Medicine, Peoria, IL, United States; Mary Meister, University of Illinois College of Medicine, Peoria, IL, United States; Ramkumar Narendran, University of Illinois College of Medicine, Peoria, IL, United States; Kejin Lee, University of Illinois College of Medicine, Peoria, IL, United States

Background: Vincristine (V) is a central chemotherapy agent for leukemia, lymphoma, and solid tumors. Levofloxacin (L) is a first line antibiotic used to treat infection and as prophylaxis against febrile neutropenia. Both drugs cause peripheral neuropathy (PN), but the cumulative effect of both drugs on PN is unknown.

Objective: To evaluate the incidence and extent of PN in pediatric oncology patients receiving vincristine and levofloxacin (VL) compared to vincristine alone (VA).

Design/Methods: This retrospective cohort study reviewed all patients with oncologic diagnoses likely to require V therapy from 2015-2020. Patients were excluded if they did not receive V, did not receive treatment at our institution, or had CNS tumors. Data extracted via chart review included age at diagnosis, gender, race, oncologic diagnosis, PN symptoms, and treatments for PN. PN symptoms were further categorized as sensory (S), motor (M), or autonomic (A). Management of PN, including need for medications, physical therapy, and/or braces, was noted. Drug exposure was calculated in cumulative dosage and number of doses.

Results: 182 patients were screened with an eligible diagnosis. 49 patients were excluded due to not having received V (35), unavailable information (10), or therapy prior to 2015 (4). 133 patients were included in the study. 53 (40%) patients were female. Mean age at diagnosis was 8.28 years (range 4 months – 30 years). 52 (39%) patients had no exposure to L (VA group) and 81 (61%) patients had exposure to L (VL group). 115 patients (86%) reported 1 or more symptoms of PN: constipation (91%), leg pain (72%), extremity weakness (57%), difficulty walking (57%), foot drop (53%), numbness/tingling of fingers/toes (40%), loss of deep tendon reflexes (25%), and jaw pain (22%). The incidence of PN was lower in the VA group (42/52, 80%) than in the VL group (73/81, 90%) (p-value 0.20). The VL group reported increased number of neuropathy symptoms compared to the VA group (p-value 0.03). More patients in the VL group reported PN symptoms spanning more than 1 category compared to the VA group (p-value 0.002). The VL group was more likely to require management of PN than the VA group (p-value 0.02). Patients are 46% more likely to have an increased number of neuropathy symptoms in the VL group compared to the VA group (β= 0.375, p-value < 0.001). Total cumulative dose of both V and L were independent predictors of having increased neuropathy symptoms (p-value < 0.05).Conclusion(s): Exposure to levofloxacin in pediatric oncology patients receiving vincristine significantly increases the burden of peripheral neuropathy.