Pharmacokinetics of vincristine in children and adolescents with acute lymphocytic leukemia

William R. Crom, Siebold S.N. de Graaf, Timothy Synold, Donald R.A. Uges, Henk Bloemhof, Gaston Rivera, Michael Christensen, Hazem Mahmoud, William E. Evans

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Abstract

We studied the pharmacokinetics of vincristine in children with acute lymphocytic leukemia by means of a specific high-performance liquid chromatographic assay with ultraviolet and electrochemical detection and a limited sampling strategy. Our objectives were to characterize the disposition of vincristine in pediatric patients, to determine clinical, demographic, or biochemical variables related to variability in vincristine pharmacokinetic parameters, and to assess the relationship between pharmacokinetic parameters and vincristine neurotoxicity. Plasma samples were collected at 5 and 30 minutes, and 1, 3, and 24 hours after a rapid intravenous injection during 3 minutes. Vincristine-induced neurotoxicity was retrospectively evaluated by chart review. Pharmacokinetic studies were completed for 64 doses in 54 children between 2 months and 18 years of age (median, 4.3 years), including 2-month-old monozygous twin girls. Vincristine clearance, estimated by Bayesian methods, was highly variable, with a mean (SD) clearance of 19.9 (14.9) ml/min per kilogram or 482 (342) ml/min per square meter. Mean clearance for all subjects was faster than in published studies of adults, which may be related in part to the greater specificity of the assay used in our study, as well as to age-related differences in drug disposition. Vincristine-associated neurotoxicity was frequent but mild and was not predicted by vincristine systemic exposure; however, neurotoxicity may have been underestimated. Clearance in one patient who received concomitant treatment with pentobarbital exceeded the 75th percentile for all patients, and four of five patients receiving concomitant histamine2 antagonists had clearances below the 25th percentile for all subjects, suggesting that drugs that induce or inhibit hepatic cytochrome P-450 enzymes may affect vincristine disposition. Further studies are needed to identify the factors responsible for interpatient variability in vincristine disposition and to develop improved dosing guidelines. (J PEDIATR 1994;125:642-9).

Original languageEnglish (US)
Pages (from-to)642-649
Number of pages8
JournalThe Journal of Pediatrics
Volume125
Issue number4
DOIs
StatePublished - Jan 1 1994

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Vincristine
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Pharmacokinetics
Bayes Theorem
Pentobarbital
Intravenous Injections
Pharmaceutical Preparations
Cytochrome P-450 Enzyme System
Demography
Guidelines
Pediatrics
Liver

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Crom, W. R., de Graaf, S. S. N., Synold, T., Uges, D. R. A., Bloemhof, H., Rivera, G., ... Evans, W. E. (1994). Pharmacokinetics of vincristine in children and adolescents with acute lymphocytic leukemia. The Journal of Pediatrics, 125(4), 642-649. https://doi.org/10.1016/S0022-3476(94)70027-3

Pharmacokinetics of vincristine in children and adolescents with acute lymphocytic leukemia. / Crom, William R.; de Graaf, Siebold S.N.; Synold, Timothy; Uges, Donald R.A.; Bloemhof, Henk; Rivera, Gaston; Christensen, Michael; Mahmoud, Hazem; Evans, William E.

In: The Journal of Pediatrics, Vol. 125, No. 4, 01.01.1994, p. 642-649.

Research output: Contribution to journalArticle

Crom, WR, de Graaf, SSN, Synold, T, Uges, DRA, Bloemhof, H, Rivera, G, Christensen, M, Mahmoud, H & Evans, WE 1994, 'Pharmacokinetics of vincristine in children and adolescents with acute lymphocytic leukemia', The Journal of Pediatrics, vol. 125, no. 4, pp. 642-649. https://doi.org/10.1016/S0022-3476(94)70027-3
Crom, William R. ; de Graaf, Siebold S.N. ; Synold, Timothy ; Uges, Donald R.A. ; Bloemhof, Henk ; Rivera, Gaston ; Christensen, Michael ; Mahmoud, Hazem ; Evans, William E. / Pharmacokinetics of vincristine in children and adolescents with acute lymphocytic leukemia. In: The Journal of Pediatrics. 1994 ; Vol. 125, No. 4. pp. 642-649.
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