Vincristine dose adjustments in adult acute lymphoblastic leukemia: impact on treatment outcomes and neuropathy.
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Vincristine remains central in adult acute lymphoblastic leukemia (ALL) therapy but frequently requires dose adjustments due to toxicity. We retrospectively analyzed 96 adults (median age 29.5 years, range 17-68) treated from 2014-2023 at a Mexican tertiary center. Overall, 79.2% had at least one vincristine dose reduction, more frequent with pediatric-inspired regimens (87.3% vs. 63.6%, OR 3.93, 95% CI 1.41-10.96, p = 0.015). Clinically significant peripheral neuropathy (PN) was reported in 35.1% before maintenance and persisted in 37% at last follow-up, associated with age ≥30 years (OR 6.78, 95% CI 2.07-22.2, p = 0.002) and cumulative vincristine >53 mg (OR 5.29, 95% CI 1.41-19.85, p = 0.014). Despite these adjustments, outcomes were unaffected: median OS was 55.2 months with dose reduction vs. 44.5 months without (HR 0.87, p = 0.707), and median EFS 40.1 vs. 19.0 months (HR 0.64, p = 0.158). Vincristine reductions did not compromise survival, supporting reevaluation of dosing to balance efficacy and long-term toxicity.