Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies

Abstract

Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outcomes for many children with ALL, the side effects and consequences of therapy are not to be underestimated. Hypertension is a well-known acute and chronic side effect of treatment for childhood ALL, although limited data are available regarding the prevalence of hypertension in children undergoing treatment for ALL. In this review of hypertension in pediatric ALL patients, we examine the existing data on incidence and prevalence during treatment and in pediatric ALL survivors. We describe independent risk factors for development of hypertension along with treatment-related causes. Long-term consequences and the risk to survivors of pediatric ALL are further defined. While many ALL patients require antihypertensive medications during some portion of their treatment, there are no clear guidelines on treating inpatient hypertension given challenges that exist in recognizing and managing hypertension in this setting and in this population. Here, we propose an algorithmic approach to diagnose and treat pediatric ALL patients with HTN, along with monitoring and continuation versus cessation of antihypertensive therapy as an outpatient.

Supportive methods for childhood acute lymphoblastic leukemia then and now: A compilation for clinical practice

“…Nevertheless, there are no uniform guidelines for the treatment of hypertension during treatment for childhood ALL. A helpful review on this topic was written by Murphy et al ( 88 ), in which an algorithm for the diagnosis and therapy of hypertension in pediatric ALL is proposed.…”

Management of acute severe hypertension in youth: from the philosophical to the practical

“…Youth with cancer are particularly at risk for acute severe hypertension due to their underlying malignancy and their treatment, including chemotherapy, radiation and complications related to surgical resection. In youth with acute lymphoblastic leukaemia, 12–45% of previously normotensive patients developed hypertension after chemotherapy induction [41]. The underlying risk factors for acute severe hypertension and target organ injury in this population often inform medication choice and blood pressure reduction targets.…”