Posterior Reversible Encephalopathy Syndrome (PRES) in Children Undergoing Allogeneic Stem Cell Transplantation

Abstract

Posterior reversible encephalopathy syndrome (PRES) is one of the most serious complication after allogeneic stem cell transplantation in paediatric setting. It is most commonly reported as adverse event of immunosuppressive strategies during transplantation. We present a case of a 7 years old girl with myelodysplastic syndrome (MDS) treated with allogeneic stem cell transplantation (ASCT) at our department. Diagnosis of PRES was confirmed by imaging techniques during the first month after transplant and it was very likely connected with cyclosporine neurotoxicity. The aim of this article is to present our first experience in diagnosing and treating PRES in paediatric stem cell transplantation. Our experience showed that PRES is one of the reasons for higher transplant related mortality in children. Early prediction of factors contributing to PRES and closely monitoring of patient’s vital signs, especially blood pressure, neurological status and vision are the main contributors for challenging the patient with another immunosuppressive agent that has less neurological toxicity. Still studies have to be initiated to confirm the influence of PRES on transplant outcome.

Patterns of central nervous system complications of post-hematopoietic stem cell transplant in pediatric oncology patients: a single institute experience

“…The literature stated that the most common finding for PRES is a high signal on T2WI and FLAIR sequences. This supported the current study results where CT and T1WI MRI findings of our PRES patients were inconclusive, and the main distinctive features were the high T2 and FLAIR signals [13].…”

“…During the follow-up, PRES was much more common at the < 100 day-post-HSCT period, during which 70.6% of PRES episodes occurred. These results are rather comparable to the findings of Veljanovska et al [13] and Siegal et al [15], which revealed that 86% of PRES episodes occurred during the first 100 days post-transplant.…”

“…While this study results match those of Veljanovska et al's [13] regarding the incidence of PRES in AlloSCT patients (4.6%), Bhatt et al's [14] revealed a markedly higher incidence (40%). Cyclosporine was part of the GVHD prevention regimen of all post-AlloSCT patients in the study diagnosed with PRES.…”