Abstract
Central nervous system (CNS) complications during treatment of childhood acute lymphoblastic leukemia (ALL) remain a challenging clinical problem. Outcome improvement with more intensive chemotherapy has significantly increased the incidence and severity of adverse events. This study analyzed the incidence of neurological complications during ALL treatment in a single pediatric institution, focusing on clinical, radiological, and electrophysiological findings. Exclusion criteria included CNS leukemic infiltration at diagnosis, therapy-related peripheral neuropathy, late-onset encephalopathy, or long-term neurocognitive defects. During a 9-year period, we retrospectively collected 27 neurological events (11%) in as many patients, from 253 children enrolled in the ALL front-line protocol. CNS complications included posterior reversible leukoencephalopathy syndrome (n = 10), stroke (n = 5), temporal lobe epilepsy (n = 2), high-dose methotrexate toxicity (n = 2), syndrome of inappropriate antidiuretic hormone secretion (n = 1), and other unclassified events (n = 7). In conclusion, CNS complications are frequent events during ALL therapy, and require rapid detection and prompt treatment to limit permanent damage.
MeSH terms
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Adolescent
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Antineoplastic Combined Chemotherapy Protocols / adverse effects*
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Asparaginase / administration & dosage
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Asparaginase / adverse effects
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Central Nervous System / drug effects
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Central Nervous System / pathology
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Central Nervous System / physiopathology
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Central Nervous System Diseases / chemically induced*
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Central Nervous System Diseases / diagnosis
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Child
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Child, Preschool
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Cytarabine / administration & dosage
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Cytarabine / adverse effects
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Daunorubicin / administration & dosage
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Daunorubicin / adverse effects
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Electroencephalography
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Female
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Humans
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Infant
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Leukemic Infiltration / chemically induced
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Leukemic Infiltration / diagnosis
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Magnetic Resonance Imaging
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Male
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Mercaptopurine / administration & dosage
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Methotrexate / administration & dosage
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Methotrexate / adverse effects
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Peripheral Nervous System Diseases / chemically induced
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Peripheral Nervous System Diseases / diagnosis
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
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Prednisone / administration & dosage
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Prednisone / adverse effects
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Retrospective Studies
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Tomography, X-Ray Computed
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Vincristine / administration & dosage
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Vincristine / adverse effects
Substances
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Cytarabine
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Vincristine
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Cyclophosphamide
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Mercaptopurine
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Asparaginase
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Prednisone
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Methotrexate
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Daunorubicin