TY - JOUR
T1 - Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia
T2 - Clinical characteristics, risk factors, course, and outcome of disease
AU - Anastasopoulou, Stavroula
AU - Eriksson, Mats A.
AU - Heyman, Mats
AU - Wang, Chen
AU - Niinimäki, Riitta
AU - Mikkel, Sirje
AU - Vaitkevičienė, Goda E.
AU - Johannsdottir, Inga Maria
AU - Myrberg, Ida Hed
AU - Jonsson, Olafur Gisli
AU - Als-Nielsen, Bodil
AU - Schmiegelow, Kjeld
AU - Banerjee, Joanna
AU - Harila-Saari, Arja
AU - Ranta, Susanna
PY - 2019/5
Y1 - 2019/5
N2 - Background: Posterior reversible encephalopathy syndrome (PRES) is a distinct entity with incompletely known predisposing factors. The aim of this study is to describe the incidence, risk factors, clinical course, and outcome of PRES in childhood acute lymphoblastic leukemia (ALL). Procedure: Patients aged 1.0 to 17.9 years diagnosed with ALL from July 2008 to December 2015 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol were included. Patients with PRES were identified in the prospective NOPHO leukemia toxicity registry, and clinical data were collected from the medical records. Results: The study group included 1378 patients, of whom 52 met the criteria for PRES. The cumulative incidence of PRES at one month was 1.7% (95% CI, 1.1–2.5) and at one year 3.7% (95% CI, 2.9–4.9). Older age (hazard ratios [HR] for each one-year increase in age 1.1; 95% CI, 1.0–1.2, P = 0.001) and T-cell immunophenotype (HR, 2.9; 95% CI, 1.6–5.3, P = 0.0005) were associated with PRES. Central nervous system (CNS) involvement (odds ratios [OR] = 2.8; 95% CI, 1.2–6.5, P = 0.015) was associated with early PRES and high-risk block treatment (HR = 2.63; 95% CI, 1.1–6.4, P = 0.033) with late PRES. At follow-up of the PRES patients, seven patients had epilepsy and seven had neurocognitive difficulties. Conclusion: PRES is a neurotoxicity in the treatment of childhood ALL with both acute and long-term morbidity. Older age, T-cell leukemia, CNS involvement and high-risk block treatment are risk factors for PRES.
AB - Background: Posterior reversible encephalopathy syndrome (PRES) is a distinct entity with incompletely known predisposing factors. The aim of this study is to describe the incidence, risk factors, clinical course, and outcome of PRES in childhood acute lymphoblastic leukemia (ALL). Procedure: Patients aged 1.0 to 17.9 years diagnosed with ALL from July 2008 to December 2015 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol were included. Patients with PRES were identified in the prospective NOPHO leukemia toxicity registry, and clinical data were collected from the medical records. Results: The study group included 1378 patients, of whom 52 met the criteria for PRES. The cumulative incidence of PRES at one month was 1.7% (95% CI, 1.1–2.5) and at one year 3.7% (95% CI, 2.9–4.9). Older age (hazard ratios [HR] for each one-year increase in age 1.1; 95% CI, 1.0–1.2, P = 0.001) and T-cell immunophenotype (HR, 2.9; 95% CI, 1.6–5.3, P = 0.0005) were associated with PRES. Central nervous system (CNS) involvement (odds ratios [OR] = 2.8; 95% CI, 1.2–6.5, P = 0.015) was associated with early PRES and high-risk block treatment (HR = 2.63; 95% CI, 1.1–6.4, P = 0.033) with late PRES. At follow-up of the PRES patients, seven patients had epilepsy and seven had neurocognitive difficulties. Conclusion: PRES is a neurotoxicity in the treatment of childhood ALL with both acute and long-term morbidity. Older age, T-cell leukemia, CNS involvement and high-risk block treatment are risk factors for PRES.
KW - ALL
KW - neuroimaging
KW - PRES
KW - seizures
U2 - 10.1002/pbc.27594
DO - 10.1002/pbc.27594
M3 - Journal article
C2 - 30592147
AN - SCOPUS:85059148663
SN - 1545-5009
JO - Pediatric Blood and Cancer
JF - Pediatric Blood and Cancer
M1 - e27594
ER -