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Background: Chemotherapy-induced peripheral polyneuropathy is a major neurotoxicity of treatment for acute lymphoblastic leukemia (ALL) in children. Pathophysiological mechanisms of the injury of peripheral neural system are not fully investigated; however, some studies have shown the involvement of vascular endothelial growth factors. Aim: To evaluate plasma levels of angiogenic growth factors in children with ALL and to identify their association with the development of vincristine-induced peripheral polyneuropathy. Materials and methods: This single center prospective study included 41 patients with ALL aged 3 to 17 years. All patients were given the ALL-MB 2015 chemotherapy regimen. Depending on the vincristine-induced peripheral polyneuropathy, the patients were divided into two groups: the main group (n = 22) comprised of the patients with neurological signs and symptoms of peripheral neuropathy and the control group (n = 19), those without clinical signs of the peripheral nervous system involvement. The levels of angiogenic growth factors (VEGF-A, VEGF-D, PlGF-1, and PDGF-BB) were measured in plasma by multiparameter immunofluorescent analysis. Results: During 3 months of the follow up the chemotherapy-induced signs of peripheral polyneuropathy developed in 53.6% (n = 22) of the children. In 72.7% (n = 16) of the patients the chemotherapy-induced peripheral polyneuropathy was characterized by a combination of neurologic abnormalities with prevailing motor symptoms. The comparative analysis of plasma angiogenic growth factors in children with ALL depending on the presence or absence of the vincristine-induced peripheral polyneuropathy showed that there was a significant decrease of the VEGF-A in those with chemotherapy-induced peripheral polyneuropathy, compared to those without (Me [Q1; Q3]: 178.20 [138.40; 228.45] and 558.50 [160.10; 650.0], respectively, p 0.017). This parameter had diagnostic sensitivity of 77.7% and specificity of 76.9%. Conclusion: We have shown a high clinical value of plasma vascular endothelial growth factor (VEGF-A) level, which makes it possible to consider it as a significant biological marker of neurotoxicity in vincristine-induced peripheral polyneuropathy.

The prevalence of cognitive impairment in patients with multiple sclerosis is 40 to 65%. Improvement of cognitive-oriented therapy and search for its new techniques is considered to be promising for slowing the progression or for recovery of cognitive functions. It is related to low efficacy of medical treatment, preserved neuroplasticity in most patients with multiple sclerosis, positive results of studies on selected cognitive rehabilitation techniques in other nervous system disorders. The spectrum of techniques for cognitive training varies from technically feasible methods using a sheet of paper and a pen to the most advanced ones, such as the use of immersive virtual reality. The effectiveness of cognitive rehabilitation in patients with multiple sclerosis with virtual reality technologies has not been studied in large-scale randomized placebo-controlled studies.

New chemotherapy agents of haematological malignancies in children often lead to adverse drug reactions, including vincristine-induced peripheral neuropathy (VIPN). The incidence of this pathology ranges from 22 to 72%. The clinic and instrumental evaluation of children with VPN, including questionaries, scales, electrodiagnostic examinations, do not provide an opportunity for prognosis and early detection of chemotherapy-related neurologic complications. Consequently, identifying biomarkers associated with VIPN is urgently warranted that discussed in this review. PubMed and Scopus were browsed based on the keywords that allowed us to select 55 articles (4 systemic reviews, 14 scientific reviews, 37 original articles) between 2017 and 2021. Reports from the included studies clearly emphasize that vincristine-induced peripheral neuropathy is associated with changes in plasma and cerebrospinal fluid (CSF) levels of the nerve growth factor (NGF) light chains of neurofilaments (NfL) and brain derived neurotrophic factor (BDNF) that are biomarkers of axonal damage. However, none of them do have criterion validity sensitivity and specificity. One of the most promising prognostic biomarkers is CХCL10 and CXCL12 that detect children with or without VIPN (sensitivity 79%, specificity 78%). The next task is finding an optimal profile of these cytokines. These cytokines together with axonal biomarkers can be used for the diagnosis and prevention of chemotherapy-induced neurotoxicity in children.