A survey on hematology‐oncology pediatric <scp>AIEOP</scp> centres: The challenge of posterior reversible encephalopathy syndrome

Zama, Daniele; Gasperini, Pietro; Berger, Massimo; Petris, Mariagrazia; Pasquale, Maria Debora De; Cesaro, Simone; Guerzoni, Maria Elena; Mastrodicasa, Elena; Savina, Francesca; Ziino, Ottavio; Kiren, Valentina; Muggeo, Paola; Mura, Raùl Morales La; Melchionda, Fraia; Zanazzo, Giulio Andrea

doi:10.1111/ejh.12984

Cited by 30 publications

(73 citation statements)

References 28 publications

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“…The present study showed that PRES was a common neurotoxicity during early ALL treatment with the NOPHO ALL2008 protocol, in line with previously reported data . Older age, T‐cell leukemia, CNS involvement at diagnosis, and high‐risk block treatment were significant risk factors for PRES.…”

Section: Discussionsupporting

confidence: 92%

“…Hypertension dominates as a sign of PRES at presentation in the present study as well as most previous reports . The exact role of hypertension in the pathogenesis of PRES remains incompletely understood .…”

Section: Discussionsupporting

confidence: 70%

“…Seizures are the most frequent symptom at PRES presentation, often with distinct EEG findings . Discontinuation of AEDs and clinical follow‐up of the patient as well as follow‐up EEG and MRI studies seems to be the appropriate strategy, as recommended in previous publications . However, the remaining diagnosis of epilepsy at last follow‐up in seven of the 50 survivors motivates further studies on the long‐term consequences of PRES.…”

Section: Discussionmentioning

confidence: 95%

“…Posterior reversible encephalopathy syndrome (PRES), first described in 1996, has been reported in children with acute lymphoblastic leukemia (ALL), usually occurring during the three first months of therapy . The reported incidence of PRES in pediatric ALL varies from 1.6% to 4.5% .…”

Section: Introductionmentioning

confidence: 99%

“…Posterior reversible encephalopathy syndrome (PRES), first described in 1996, 1 has been reported in children with acute lymphoblastic leukemia (ALL), usually occurring during the three first months of therapy. [2][3][4][5][6][7] The reported incidence of PRES in pediatric ALL varies from 1.6% to 4.5%. [2][3][4][5][6][7] Endothelial and blood-brain barrier dysfunction are the main underlying pathophysiological mechanisms causing PRES, 8 and it has been speculated that hypertension and the cytotoxic effect of pharmacological treatments constitute triggering factors.…”

Section: Introductionmentioning

confidence: 99%

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Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Anastasopoulou

Eriksson

Heyman

et al. 2018

Pediatric Blood & Cancer

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Anastasopoulou

Eriksson

Heyman

et al. 2018

Pediatric Blood & Cancer

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The spectrum of acute central nervous system symptoms during the treatment of childhood acute lymphoblastic leukaemia

Banerjee

Niinimäki

Lähteenmäki

et al. 2019

Pediatric Blood & Cancer

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BackgroundChildren with central nervous system (CNS) toxicity during therapy for acute lymphoblastic leukaemia (ALL) are at risk for treatment modifications, long‐term sequelae and even higher mortality. A better understanding of CNS symptoms and their complications improves the potential to prevent and treat them.MethodsPatient files from 649 children treated with Nordic Society of Pediatric Hematology and Oncology ALL92 and ALL2000 protocols in Finland were reviewed retrospectively for any acute CNS symptom. Detailed data on symptoms, examinations and treatment of the underlying CNS complications were collected from the medical records. Disease‐related and outcome data were retrieved from the Nordic leukaemia registry.ResultsAltogether, 13% (86) of patients with ALL had acute CNS symptoms. Most symptoms (64%) occurred during the first 2 months of therapy. Posterior reversible encephalopathy syndrome was the most frequent complication (4.5%). Cerebrovascular events were diagnosed in 10 cases (1.6%), while methotrexate‐related stroke‐like syndrome (SLS) was observed in only one patient (0.2%). CNS symptoms due to systemic or unclear conditions, especially sepsis, were important for differential diagnosis. CNS leukaemia was associated with CNS symptoms (hazard ratio [HR] = 4.03; P = .003), and epilepsy was a common sequel of CNS complications (19%).ConclusionsAcute CNS symptoms are common during ALL therapy, occurring mainly during the first 2 months of treatment. Patients with CNS leukaemia at diagnosis are at a higher risk for CNS toxicity. Despite intensive CNS‐directed methotrexate treatment, SLS was diagnosed extremely rarely in our series.

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Peak blood pressure and prediction of posterior reversible encephalopathy syndrome in children

2020

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A survey on hematology‐oncology pediatric AIEOP centres: The challenge of posterior reversible encephalopathy syndrome

Cited by 30 publications

References 28 publications

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease

The spectrum of acute central nervous system symptoms during the treatment of childhood acute lymphoblastic leukaemia

Peak blood pressure and prediction of posterior reversible encephalopathy syndrome in children

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