Magnetic resonance imaging of the brain in survivors of childhood acute lymphoblastic leukemia

Abstract

The issue of delayed neurological damage as a result of treatment is becoming increasingly important now that an increased number of children survive treatment for acute lymphoblastic leukemia (ALL). Following modification of the treatment protocols, severe symptomatic late effects are rare, and most adverse effects are detected by sensitive imaging methods such as magnetic resonance imaging (MRI) or by neuropsychological testing. In this study we aimed to determine the prevalence and characteristics of late central nervous system (CNS) damage by MRI and clinical examination in children treated for ALL. A cross-sectional study was carried out at the pediatric oncology unit of Zagazig University, Egypt, and included 25 patients who were consecutively enrolled and treated according to the modified Children’s Cancer Group (CCG) 1991 protocol for standard risk ALL and the modified CCG 1961 protocol for high-risk ALL and who had survived more than 5 years from the diagnosis. All relevant data were collected from patients’ medical records; particularly the data concerning the initial clinical presentation and initial brain imaging. All patients were subjected to thorough history and full physical examination with special emphasis on the neurological system. MRI of the brain was performed for all patients. The mean age of patients was 6.9±3.04 years at diagnosis and was 12.9±3.2 years at the time of study. The patients comprised 14 boys and 11 girls. Abnormal MRI findings were detected in six patients (24%). They were in the form of leukoencephalopathy in two patients (8%), brain atrophy in two patients (8%), old infarct in one patient (4%) and old hemorrhage in one patient (4%). The number of abnormal MRI findings was significantly higher in high-risk patients, patients who had CNS manifestations at diagnosis and patients who had received cranial irradiation. We concluded that cranial irradiation is associated with higher incidence of MRI changes in children treated for ALL. Limitation of cranial irradiation to selected patients contributed to a lower incidence of neurological complications in our study. MRI is a sensitive radiological tool to detect structural changes in children treated for ALL, even in asymptomatic cases.

Isolated CNS Relapse in Acute Lymphoblastic Leukemia (ALL): An Experience from a Tertiary Care Center

“…The CR rates reach up to 70 to 80%. 14 Isolated CNS relapse in ALL patients is rare as limited data are available from India on literature search. Hence an attempt was made to compile and present the data of ALL cases with isolated CNS relapse and compare the clinicopathological profile of these cases with the final outcome.…”

Structural and Functional Brain Imaging in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia Treated With Chemotherapy: A Systematic Review

“…Additionally, higher plasma concentration of MTX was associated with thicker cortices in the dorsal lateral prefrontal cortex, a region involved in executive functioning ( 6 ). Brain abnormalities that were less prevalent, but still observed in ALL survivors, included cerebral microangiopathy, brain atrophy, infarcts, and hemorrhage ( 28 , 38 ).…”

“…Additional white matter abnormalities were detected by structural T1-weighted, T2-weighted, and fluid-attenuated inversion recovery MRI sequences. Five studies reported that a subset of survivors developed acute and/or persistent leukoencephalopathy ( 28 , 31–33 , 45 ), a condition associated with apparent white matter damage (ie, myelin damage) and defined by T2-weighted hyperintensity in white matter. Risk for leukoencephalopathy was highest among patients receiving more intensive therapy and higher doses of MTX ( 28 , 33 ).…”

Magnetic resonance imaging of changes in the brain of children cured of acute lymphoblastic leukemia

“…Leukoencephalopathy is a characteristic complication caused by the intrathecal administration of Methothrexate, Cisplatinand, Cytarabine and Carmustine. 2 Toxic effects induced by Methothrexate are the most common in pediatric patients with leukemia. neurotoxicity can be divided into early and late leukoencephalopathy.…”