Central nervous system complications during treatment of acute lymphoblastic leukemia in a single pediatric institution.
Central nervous system (CNS) complications during treatment of childhood acute lymphoblastic leukemia (ALL) remain a challenging clinical problem. Outcome improvement with more intensive chemotherapy has significantly increased the incidence and severity of adverse events. This study analyzed the incidence of neurological complications during ALL treatment in a single pediatric institution, focusing on clinical, radiological, and electrophysiological findings. Exclusion criteria included CNS leukemic infiltration at diagnosis, therapy-related peripheral neuropathy, late-onset encephalopathy, or long-term neurocognitive defects. During a 9-year period, we retrospectively collected 27 neurological events (11%) in as many patients, from 253 children enrolled in the ALL front-line protocol. CNS complications included posterior reversible leukoencephalopathy syndrome (n = 10), stroke (n = 5), temporal lobe epilepsy (n = 2), high-dose methotrexate toxicity (n = 2), syndrome of inappropriate antidiuretic hormone secretion (n = 1), and other unclassified events (n = 7). In conclusion, CNS complications are frequent events during ALL therapy, and require rapid detection and prompt treatment to limit permanent damage.
Parasole
Rosanna
R
Department of Pediatric Hemato-Oncology, Santobono-Pausilipon Hospital, Napoli, Italy. rparasol@libero.it
Petruzziello
Fara
F
Menna
Giuseppe
G
Mangione
Argia
A
Cianciulli
Emilio
E
Buffardi
Salvatore
S
Marchese
Luciano
L
Nastro
Anna
A
Misuraca
Aldo
A
Poggi
Vincenzo
V
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D002490:Central Nervous System / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D002493:Central Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D017254:Leukemic Infiltration / Q000139:chemically induced / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000175:diagnosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D003561:Cytarabine; D014750:Vincristine; D003520:Cyclophosphamide; D015122:Mercaptopurine; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate; D003630:Daunorubicin