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Posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia: Clinical characteristics, risk factors, course, and outcome of disease
Author(s) -
Anastasopoulou Stavroula,
Eriksson Mats A.,
Heyman Mats,
Wang Chen,
Niinimäki Riitta,
Mikkel Sirje,
Vaitkevičienė Goda E.,
Johannsdottir Inga Maria,
Myrberg Ida Hed,
Jonsson Olafur Gisli,
AlsNielsen Bodil,
Schmiegelow Kjeld,
Banerjee Joanna,
HarilaSaari Arja,
Ranta Susanna
Publication year - 2019
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27594
Subject(s) - medicine , posterior reversible encephalopathy syndrome , hazard ratio , cumulative incidence , incidence (geometry) , pediatrics , odds ratio , acute lymphocytic leukemia , prospective cohort study , leukemia , lymphoblastic leukemia , cohort , confidence interval , physics , magnetic resonance imaging , optics , radiology
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.