Severe Neurotoxicities in a Case of Charcot-Marie-Tooth Disease Type 2 Caused by Vincristine for Acute Lymphoblastic Leukemia

Abstract

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.

Medical anticancer treatment of lung cancer associated with comorbidities: A review

“…Those include a case of ovarian cancer treated by carboplatin and paclitaxel with which the patient was unable to walk, write or drive [60] and in children treated by vincristine for acute lymphoblastic leukemia and who became unable to walk [61,62]. In some cases, the deterioration was mild like for an osteosarcoma treated by cisplatin and adriamycin [63] or is slowly reversible as suggested by the history of a patient with non-Hodgkin's lymphoma treated by vincristine [64].…”

Successful treatment of nasopharyngeal cancer using radiotherapy with concurrent cetuximab in a patient with Charcot-Marie-Tooth disease

“…Vincristine is a well-known drug for its toxicity in patients with cancer, and in particular in patients with CMT 4. Some of the cases report severe toxicities in patients with CMT disease due to vincristine, whereas others report the diagnosis of CMT disease following toxicity due to vincristine 8–11. Paclitaxel is another common chemotherapeutic agent known to cause neuropathy 12–14.…”

Successful Treatment of Amyloid Light-chain Amyloidosis in a Charcot-Marie-Tooth Disease Patient with Lenalidomide, Cyclophosphamide, and Dexamethasone

“…However, because CMT patients tend to live longer, they may also suffer from several malignant neoplasms, in which case the potential neurotoxicity of anticancer agents becomes a matter for concern. Anticancer drugs have been reported (21) to induce severe neuralgic amyotrophy, and vincristine, one of the most neurotoxic agents, induces severe peripheral neuropathy (10,11). Weimer et al described medication-induced exacerbation of neuropathy in CMT and proposed a list of medications of concern for patients with CMT.…”