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Abstract
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.
Acknowledgements
This article is dedicated to the memory of Prof. Bruno Rotoli, Master in Hematology.
The authors are grateful to Prof. Bruno Rotoli from the Federico II University of Naples for valuable revision of the manuscript, and Dr Alessandra Trocino, Librarian at the National Cancer Institute of Naples, for the bibliographic assistance.
The study was presented at the 50th Congress of the American Society of Hematology (ASH), 6–9 December 2008, San Francisco, California.
Declaration of interest: The study was supported by the Associazione Spider Campania Onlus.