Vincristine-Related Peripheral Neurotoxicity and Fine Motor Function in Pediatric Acute Lymphoblastic Leukemia: A Systematic Review

Abstract

Vincristine-induced peripheral neuropathy (VIPN) is a frequent treatment-related complication of pediatric acute lymphoblastic leukemia (ALL), but its relationship with fine motor function across treatment phases remains unclear. This systematic review synthesized evidence on the association between vincristine-related peripheral neurotoxicity and fine motor function in pediatric ALL, with particular attention to maintenance chemotherapy. MEDLINE via PubMed, Scopus, and Dimensions were searched from inception through August 22, 2026, supplemented by backward reference screening and forward citation tracking. Eligible studies reported either directly measured chemotherapy-induced peripheral neuropathy/VIPN or vincristine exposure together with an extractable fine motor outcome. Evidence was classified as direct neurotoxicity assessment (Tier 1) or vincristine dose, schedule, frequency, or timing (Tier 2), appraised using design-specific Joanna Briggs Institute tools, and synthesized narratively. Of 168 records identified, seven reports representing six unique cohorts were included. Fine motor abnormalities were reported during active treatment, maintenance, post-treatment follow-up, and long-term survivorship. Associations between directly measured neuropathy and fine motor function were inconsistent, while cumulative vincristine exposure generally showed no clear dose–response relationship with fine motor performance. Manual dexterity and coordination deficits could persist despite relatively preserved broader fine motor composite scores. Directly measured neurotoxicity and vincristine exposure should therefore be regarded as related but distinct constructs. Paired assessment of peripheral neurotoxicity and domain-specific fine motor function may improve characterization of treatment-related functional impairment across the ALL treatment continuum.