title: Central nervous system chemotoxicity during treatment of pediatric acute lymphoblastic leukemia/lymphoma.
abstract: In the last decades, increasing success rates are being obtained in the chemotherapy of pediatric leukemia and lymphoma. However, the cornerstone of this treatment is still formed by a reduced number of drugs with a highly toxic profile. In particular, central nervous system complications remain a challenging clinical problem, requiring rapid detection and prompt treatment to limit permanent damage. Furthermore, clinicians are often challenged to discriminate between CNS involvement by the disease, toxicity of drugs or infections. This clinically oriented review will help recognize and handle the main neurologic adverse effects induced by chemotherapy in pediatric patients with lymphoblastic leukemia/lymphoma. Different clinical entities and putative drugs involved are discussed in each chapter, with clinical cases illustrating the most relevant and challenging events. In addition, specific clinical-radiological patterns of some of these neurologic events are detailed. Finally, the role of pharmacogenetics, with special focus on those polymorphisms that could help explain the occurrence of neurotoxicity, is also discussed.
authors.affiliation: Service of Pediatric Hematology, Materno Infantil Hospital, Badajoz, Spain. jvagacev@aehh.org
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Vagace
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: de la Maya
authors.forename: Cristina
authors.initials: C
authors.lastname: Caceres-Marzal
authors.forename: Silvia
authors.initials: S
authors.lastname: Gonzalez de Murillo
authors.forename: Guillermo
authors.initials: G
authors.lastname: Gervasini
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020258:Neurotoxicity Syndromes; D010597:Pharmacogenetics; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D020521:Stroke / Q000139:chemically induced / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents