Vincristine can lead to which of the following major side effects?

Vincristine is a vinca alkaloid commonly used in chemotherapy, particularly for certain types of leukemia and lymphoma. One of the well-documented major side effects associated with vincristine is neuropathic pain, which results from the drug's neurotoxic effects. Vincristine can cause peripheral neuropathy, manifesting as symptoms such as pain, tingling, and weakness in the extremities. This is due to the drug's action on microtubules, which disrupts the normal function of nerve cells.

The other options presented are not typically associated with vincristine. For instance, hypertension is not a common side effect of vincristine, and while some chemotherapeutic agents can cause changes in blood pressure, vincristine is not known for this effect. Anaphylaxis, a severe allergic reaction, is also rare with vincristine as it does not usually trigger an immune response of that nature. Hyperpigmentation can occur with some chemotherapy drugs, but it is not a well-known or major side effect of vincristine specifically, which is primarily associated with its neurotoxic properties. Thus, neuropathic pain stands out as the notable major side effect linked to vincristine treatment.