Severe permanent encephalopathy in acute lymphoblastic leukemia.
As survival rates for childhood acute lymphoblastic leukemia have increased, concerns over improved quality-of-life have also increased. Although 3-10% of children may experience acute transient neurotoxicity during induction chemotherapy, they are felt to be at low risk for late sequelae. We report three previously healthy boys with newly-diagnosed acute lymphoblastic leukemia who presented with obtundation and severe seizures during late induction with a standard four drug chemotherapy regimen. While all three are disease-free survivors, they unexpectedly have persistent and medically intractable partial complex seizures, broad-based neuropsychological impairment and striking neuroimaging abnormalities. These findings suggest that children with leukemia who develop an acute encephalopathy during induction chemotherapy are at risk for long-term neurological and neuropsychological sequelae, despite the cessation of further potentially neurotoxic therapy.
Maria
B L
BL
Department of Pediatrics, University of Florida College of Medicine, Gainesville 32610.
Dennis
M
M
Obonsawin
M
M
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001288:Attention / Q000187:drug effects; D001927:Brain Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007361:Intelligence Tests; D007802:Language; D008297:Male; D008568:Memory / Q000187:drug effects; D008570:Memory, Short-Term / Q000187:drug effects; D009483:Neuropsychological Tests; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D012640:Seizures / Q000139:chemically induced; D014057:Tomography, X-Ray Computed