Results
Seven patients were identified and included, three female, four male.All
children were between two years and four years, all had a diagnosis of
ALL.None of the patients had any underlying comorbidities prior to their
diagnosis of ALL. (table 1)
Symptom onset in five of the patients was during induction chemotherapy
after just 2-4 weekly doses of vincristine. In two cases vcp was
diagnosed later during blocks of vincristine containing chemotherapy. In
both cases vcp was preceded by other signs of neuropathy including very
poor mobility, ptosis and a squint. In all patients vocal cord paralysis
presented as increased work of breathing and stridor. Six patients
sustained bilateral and one patient a left, unilateral vcp.Of the
bilateral cases, four required surgical tracheostomy and the remaining
three were managed conservatively with no need for airway protection.
All patients recovered from vocal cord paralysis despite all but one
patient receiving further vincristine. Regimes and doses were adjusted
to a level of vincristine exposure deemed necessary by the treating
haematologist to achieve long term leukaemia remission. Chemotherapy
regimes were modified in all cases to reduce vincristine exposure and in
some cases patients were switched to an alternative chemotherapy regime
not containing vincristine for consolidation and interim maintenance
phases of treatment. Doses in induction and consolidation phases were
omitted from the time of diagnosis of vcp.
Vincristine was reintroduced in all patients with tracheostomies for the
intensive phases of chemotherapy. One patient without a tracheostomy was
given vinblastine instead of vincristine as the risk of neurotoxicity is
felt to be lower with this agent.
No patients were given the usual monthly vincristine doses in the
prolonged maintenance phase of treatment.
All children with tracheostomies were eventually decannulated up to one
year following the surgery at a point where no further vincristine was
planned. One patient developed subglottic stenosis and whilst
decannulated may require laryngotracheal reconstruction for impaired
exercise tolerance.
There have been no cases of leukaemia relapse in this patient cohort