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Rokkanen R, Aarnivala H, Pokka T, Niinimäki R. Chemotherapy-related toxicities follow a typical pattern in children treated for acute lymphoblastic leukaemia. Acta Paediatr 2024; 113:1103-1111. [PMID: 38178211 DOI: 10.1111/apa.17092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
AIM Acute lymphoblastic leukaemia (ALL) therapy has been associated with a significant burden of toxicities. The aim of this study was to describe the full spectrum of toxic effects associated with childhood ALL. METHODS Toxicity-related data were collected from the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-2008 toxicity registry, in which data on 19 clinically relevant toxicities were registered during ALL treatment, and from patient medical records. All patients treated according to the NOPHO ALL-2008 protocol in Oulu University Hospital between 2008 and 2020 were included in the study. RESULTS The cohort consisted of 73 patients, 38 of whom were male. Mean age at diagnosis was 6.6 ± 4.2 (range 1.4-16.0) years. All but one of the patients developed at least one treatment-related toxicity and more than half had multiple toxicities. Female sex and older age were associated with a higher tendency towards toxicity. The most common toxicity was vincristine-induced peripheral neuropathy, which was observed in 70 patients. Most toxicities were moderate or severe, but even mild toxicities often affected leukaemia treatment. CONCLUSION Moderate and severe treatment-related toxicities are common, and most toxicities occur in a typical pattern in relation to the treatment phases.
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Affiliation(s)
- Roosa Rokkanen
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Henri Aarnivala
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Riitta Niinimäki
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
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Siegel BI, Gust J. How Cancer Harms the Developing Brain: Long-Term Outcomes in Pediatric Cancer Survivors. Pediatr Neurol 2024; 156:91-98. [PMID: 38735088 DOI: 10.1016/j.pediatrneurol.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 02/22/2024] [Accepted: 03/31/2024] [Indexed: 05/14/2024]
Abstract
Survival rates for pediatric cancer are improving, resulting in a rising need to understand and address long-term sequelae. In this narrative review, we summarize the effects of cancer and its treatment on the developing brain, with a focus on neurocognitive function in leukemia and pediatric brain tumor survivors. We then discuss possible mechanisms of brain injury and management considerations.
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Affiliation(s)
- Benjamin I Siegel
- Brain Tumor Institute, Children's National Hospital, Washington, District of Columbia; Division of Pediatric Hematology and Oncology, Children's National Hospital, Washington, District of Columbia
| | - Juliane Gust
- Department of Neurology, University of Washinton, Seattle, Washington; Seattle Children's Research Institute, Center for Integrative Brain Research, Seattle, Washington.
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3
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Hamoda A, Bedair M, Semary SF, Youssef A, Hafez H. Patterns and Outcomes of Acute Central Nervous System Complications During Treatment of Childhood Acute Lymphoblastic Leukemia: A Single-center Experience. J Pediatr Hematol Oncol 2024; 46:72-79. [PMID: 38132573 DOI: 10.1097/mph.0000000000002797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
Central nervous system (CNS) complications are considered adverse events during the treatment of pediatric acute lymphoblastic leukemia (ALL). This study aimed to assess the incidence, types, clinical and radiologic patterns, risk factors, and the fate of different CNS complications during the treatment of pediatric ALL. A retrospective study included 390 patients with pediatric ALL, treated according to St. Jude total XV protocol at the National Cancer Institute, Cairo University, from January 2012 to December 2017. Thirty-nine (10%) patients developed different types of CNS complications. Nineteen (4.9%) patients had cerebrovascular complications, 12 (3.1%) patients had posterior reversible encephalopathy syndrome (PRES), and 6 (1.5%) patients had leukoencephalopathy; both CNS infections and leukemic infiltrates were diagnosed in one patient each. CNS complications were significantly higher in patients older than 10 years old, patients with high-risk disease, and patients who were classified as CNS III status with a statistically significant P value of 0.040, 0.020, and 0.002, respectively. There were 31 (79.5%) cases that achieved complete recovery, 6 (15.4%) patients who died, and 2 (5.1%) patients who developed residual neurological deficits. In conclusion, pediatric patients with ALL, who presented with older age, high-risk disease initially, and had initial CNS III status, were at higher risk of developing acute CNS complications during their treatment period. Patients who developed visual disturbances were associated with unfavorable outcomes. Despite that, around 80% of patients showed complete recovery, but still, 15% of them died from these complications.
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Affiliation(s)
- Asmaa Hamoda
- Department of Pediatric Oncology, National Cancer Institute - Cairo University
- Department of Pediatric Oncology, Children Cancer Hospital, Egypt (57357 Hospital), Cairo
| | - Mohamed Bedair
- Department of Pediatric Oncology, Damietta Cancer Institute, Damietta
| | - Samah Fathy Semary
- Department of Pediatric Oncology, Children Cancer Hospital, Egypt (57357 Hospital), Cairo
- Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ayda Youssef
- Department of Radiodiagnosis, National Cancer Institute - Cairo University
- Department of Radiodiagnosis, Children Cancer Hospital, Egypt (57357 Hospital), Cairo
| | - Hanafy Hafez
- Department of Pediatric Oncology, National Cancer Institute - Cairo University
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Barnbrock A, Lüsebrink N, Schubert-Bast S, Bochennek K, Lehrnbecher T. No role for electroencephalogram in the initial work-up of pediatric acute lymphoblastic leukemia. Support Care Cancer 2023; 31:241. [PMID: 36976383 PMCID: PMC10050029 DOI: 10.1007/s00520-023-07692-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The purpose of this study was to verify whether there is a prognostic benefit of electroencephalogram (EEG) performed during initial work-up of children with newly diagnosed acute lymphoblastic leukemia (ALL). METHODS In this retrospective monocenter study, we analyzed the value of electroencephalogram (EEG) performed during initial work-up of children with newly diagnosed acute lymphoblastic leukemia (ALL). All pediatric patients were included in this study who were diagnosed with de novo ALL in our institution between January 1, 2005, and December 31, 2018, and in whom an EEG was performed for initial work-up within 30 days of diagnosis of ALL. EEG findings were associated with the occurrence and the etiology of neurologic complications occurring during intensive chemotherapy. RESULTS Out of 242 children, EEG revealed pathological findings in 6 patients. Two of them developed a seizure at a later time point due to adverse effects of chemotherapy, whereas 4 children had an uneventful clinical course. In contrast, 18 patients with normal initial EEG findings developed seizures during therapy for different reasons. CONCLUSION We conclude that routine EEG does not predict seizure susceptibility in children with newly diagnosed ALL and is unnecessary in the initial work-up as EEG investigation in young and often sick children requires sleep deprivation and/or sedation, and our data demonstrate no benefit in predicting neurological complications.
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Affiliation(s)
- Anke Barnbrock
- Department of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Goethe University Frankfurt, Frankfurt, Germany
| | - Natalia Lüsebrink
- Department of Neuropediatrics, Hospital for Children and Adolescents, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Schubert-Bast
- Department of Neuropediatrics, Hospital for Children and Adolescents, Goethe University Frankfurt, Frankfurt, Germany
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | - Konrad Bochennek
- Department of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Lehrnbecher
- Department of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Goethe University Frankfurt, Frankfurt, Germany.
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Heidari S, Panahishokouh M, Babakhani D, Aghabeigi S, Vaezi M, Amini S, Hadjibabaie M, Shahrami B. Vincristine-Induced Seizure from Drug Interactions: A Case Report and Review of Literature. Case Rep Oncol 2023; 16:363-371. [PMID: 37384200 PMCID: PMC10293935 DOI: 10.1159/000530655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/28/2023] [Indexed: 06/30/2023] Open
Abstract
Vincristine (VCR) as a key drug for the treatment of acute lymphoblastic leukemia (ALL) is associated with neurotoxicity. We present a young man with a history of controlled childhood seizures who was diagnosed with pre-B-cell ALL and developed generalized tonic-clonic seizures following the Cancer and Leukemia Group B (CALGB) 8811 regimen. The patient also received oral itraconazole to prevent fungal infection initiated by chemotherapy. Possible causes of seizure, including electrolyte abnormalities, hypoglycemia, central nervous system infection or inflammation, were ruled out. According to the Naranjo Adverse Drug Reaction Scale, the patient's seizure had been attributed to VCR, possibly secondary to concomitant use of itraconazole and doxorubicin. The patient successfully recovered after discontinuation of VCR and supportive care. Clinicians should be aware of the possibility of vincristine-induced seizure in adult patients, especially with the concomitant use of drugs known to have potential drug-drug interactions.
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Affiliation(s)
- Shima Heidari
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Panahishokouh
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Davoud Babakhani
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sohrab Aghabeigi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vaezi
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahideh Amini
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Molouk Hadjibabaie
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Shahrami
- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Hematology, Oncology and Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology, and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran
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刘 京, 陆 爱, 左 英, 吴 珺, 黄 志, 贾 月, 丁 明, 张 乐, 秦 炯. [Clinical characteristics and prognosis of seizures in 75 children with acute lymphoblastic leukemia]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54:948-953. [PMID: 36241238 PMCID: PMC9568387 DOI: 10.19723/j.issn.1671-167x.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics, treatment, and prognosis of seizures in children with acute lymphoblastic leukemia (ALL) during chemotherapy. METHODS Children with ALL with seizures during chemotherapy admitted to the Department of Pediatrics, Peking University People's Hospital from January 2010 to March 2022 were retrospectively analyzed. Clinical data including the incidence of seizure, time at seizure onset, causes, management, and prognosis were collected retrospectively. RESULTS A total of 932 children with ALL were admitted during the study period, of whom, 75 (8%) were complicated with seizures during the period of chemotherapy. There were 40 males and 35 females, with a median age of 7.5 (1-17) years, and 43 cases (57.3%) occurred within the first 2 months of chemotherapy. The underlying diseases were reversible posterior encephalopathy syndrome (n=15), cerebral hemorrhage (n=10, one of whom was complicated with venous sinus thrombosis), intrathecal or systemic methotrexate administration (n=11), brain abscess (n=7, fungal infection in 3 cases, and bacterial in 4), viral encephalitis (n=2), febrile seizure (n=7), hyponatremia (n=7), hypocalcemia (n=2), and unknown cause (n=14). Sixty-four children underwent neuroimaging examination after seizure occurrence, of whom 37 (57.8%) were abnormal. The electroencephalograhpy (EEG) was performed in 44 cases and was abnormal in 24 (54.4%). Fifty-five patients remained in long-term remission with regular chemotherapy, 8 patients received hematopoietic stem cell transplantation, 9 died and 3 lost to follow-up. Symptomatic epilepsy was diagnosed in 18 cases (24%), and was well controlled in 16 with over 1 year of seizure-free. Whereas 2 cases were refractory to anti-seizure medications. CONCLUSION Seizures are relatively common in children with ALL, most commonly due to reversible posterior encephalopathy syndrome, methotrexate-related neurotoxicity, and cerebral hemorrhage. Seizures occurred within 2 months of chemotherapy in most cases. Neuroimaging and EEG should be performed as soon as possible after the first seizure onset to identify the etiology and to improve the treatment regimen. Some cases developed symptomatic epilepsy, with a satisfactory outcome of seizure remission mostly after concurrent antiseizure medication therapy.
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Affiliation(s)
- 京 刘
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 爱东 陆
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 英熹 左
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 珺 吴
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
- 北京大学首钢医院儿科, 北京 100144Department of Pediatrics, Peking University Shougang Hospital, Beijing 100144, China
| | - 志卓 黄
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 月萍 贾
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 明明 丁
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 乐萍 张
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
| | - 炯 秦
- 北京大学人民医院儿科, 北京 100044Department of Pediatrics, Peking University People's Hospital, Beijing 100044, China
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Schmiegelow K. EXABS-103-ALL Advances in ALL Diagnosis and Treatment -The NOPHO Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22 Suppl 2:S6-S8. [PMID: 36164232 DOI: 10.1016/s2152-2650(22)00641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Kjeld Schmiegelow
- Faculty of Health and Clinical Sciences, University of Copenhagen, Blegdamsvej 3, Copenhagen, 2200, Denmark; Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
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8
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Cruz-Chávez DA, López-Pérez BJ, Solórzano-Gómez E, Venta-Sobero JA, Flores-Villegas LV, Toledo-Lozano CG, Castro-Loza GV, Sandoval-Pacheco R, Torres-Vallejo A, Marmol-Realpe KSF, Flores-Jurado YE, Hernández-Soriano CL, Alcaraz-Estrada SL, Mondragón-Terán P, Suárez-Cuenca JA, Coral-Vázquez RM, Garcia S. Neurological Involvement in Pediatric Patients with Acute Leukemia: A Retrospective Cohort. CHILDREN 2022; 9:children9091268. [PMID: 36138577 PMCID: PMC9496928 DOI: 10.3390/children9091268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022]
Abstract
Acute leukemia (AL) is an important cause of morbidity and mortality in children, and neurological manifestations (NM) are frequent. The objective of this study was to analyze neurological manifestations in children with acute leukemia from cases attended in the last five years at the Centro Médico Nacional “20 de Noviembre”. Methods: Conducting a retrospective and analytical study from 1 January 2015 to 31 December 2020 in children with AL classified according to sex, age range and AL type. Participants were grouped according the presence of NM. Results: We analyzed 607 patients: 54.85% boys and 44.14% girls, with a mean age of 7.27 ± 4.54 years. When comparing groups, the NM group was significantly older (p = 0.01), and the highest prevalence was between 6 and 12 years old. ALL was predominant over the other lineages (p ≤ 0.01). The most frequent NM was CNS infiltration, seizures, headache and neuropathy. Death outcomes occurred in 18.7% of children with AML, 11.8% with ALL and 50% with MPAL (p ≤ 0.002). The NM group was associated with higher mortality during a follow-up time of 77.9 ± 49 months (44.4% vs. 8.9% deaths, NM vs. non-NM, respectively; OR = 3.3; 95% CI 2.4 to 4.6; p ≤ 0.0001). Conclusions: ALL was the most prevalent leukemia type. CNS infiltration, seizures, headache, neuropathy and PRES were the most frequent symptoms in the NM group. NM was associated with a higher mortality rate.
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Affiliation(s)
- Diana Alejandra Cruz-Chávez
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Brian Javier López-Pérez
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Elsa Solórzano-Gómez
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - José Antonio Venta-Sobero
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Luz Victoria Flores-Villegas
- Department of Pediatric Hematology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Christian Gabriel Toledo-Lozano
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-5519562089 (C.G.T.-L.); +52-5554377491 (S.G.)
| | - Gabriela Vianney Castro-Loza
- Department of Undergraduate Research, Hospital Militar de Especialidades de la Mujer y Neonatología, Mexico City 11200, Mexico
| | - Roberto Sandoval-Pacheco
- Department of Undergraduate Research, Hospital Militar de Especialidades de la Mujer y Neonatología, Mexico City 11200, Mexico
| | - Andrea Torres-Vallejo
- Department of Pediatric Endocrinology, Instituto Nacional de Pediatría, Mexico City 03700, Mexico
| | - Karen Sharlot Faisury Marmol-Realpe
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Yazmín Evelyn Flores-Jurado
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Cristal Lucero Hernández-Soriano
- Department of Pediatric Neurology, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Sofía Lizeth Alcaraz-Estrada
- Department of Genomic Medicine, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Paul Mondragón-Terán
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Juan Antonio Suárez-Cuenca
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
| | - Ramón Mauricio Coral-Vázquez
- Department of Teaching and Research, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
- Postgraduate Section, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Silvia Garcia
- Department of Neuroscience, Centro Médico Nacional “20 de Noviembre”, Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado, Mexico City 03229, Mexico
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-5519562089 (C.G.T.-L.); +52-5554377491 (S.G.)
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Anastasopoulou S, Harila-Saari A, Als-Nielsen B, Eriksson MA, Heyman M, Johannsdottir IM, Marquart HV, Niinimäki R, Pronk CJ, Schmiegelow K, Vaitkeviciene G, Thastrup M, Ranta S. Does minimal central nervous system involvement in childhood acute lymphoblastic leukemia increase the risk for central nervous system toxicity? Pediatr Blood Cancer 2022; 69:e29745. [PMID: 35488712 DOI: 10.1002/pbc.29745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
Abstract
Central nervous system (CNS) involvement in childhood acute lymphoblastic leukemia (ALL) implicates enhanced intrathecal chemotherapy, which is related to CNS toxicity. Whether CNS involvement alone contributes to CNS toxicity remains unclear. We studied the occurrence of all CNS toxicities, seizures, and posterior reversible encephalopathy syndrome (PRES) in children with ALL without enhanced intrathecal chemotherapy with CNS involvement (n = 64) or without CNS involvement (n = 256) by flow cytometry. CNS involvement increased the risk for all CNS toxicities, seizures, and PRES in univariate analysis and, after adjusting for induction therapy, for seizures (hazard ratio [HR] = 3.33; 95% confidence interval [CI]: 1.26-8.82; p = 0.016) and PRES (HR = 4.85; 95% CI: 1.71-13.75; p = 0.003).
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Affiliation(s)
- Stavroula Anastasopoulou
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Bodil Als-Nielsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mats Anders Eriksson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Neuropediatric Unit, Karolinska Institutet, Stockholm, Sweden
| | - Mats Heyman
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | | | - Hanne Vibeke Marquart
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Riitta Niinimäki
- Department of Children and Adolescents, Oulu University Hospital and University of Oulu, PEDEGO Research Unit, Oulu, Finland
| | | | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Goda Vaitkeviciene
- Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania
| | - Maria Thastrup
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanna Ranta
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
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10
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Soma SA, Jamal CY, Chowdhury I. Etiology and Outcome of Seizures in Children during Induction Remission Chemotherapy for Acute Lymphoblastic Leukaemia. ASIAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.1055/s-0042-1748322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractSeizure is one of the most frequent neurological complication and morbid phenomenon among children receiving chemotherapy for acute lymphoblastic leukemia. As overall survival of children with acute lymphoblastic leukemia is improving, now the challenge is to reduce treatment-related adverse effect. However, not much is known about the etiology and natural history of these seizure in our pediatric population. This is a single centered study conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University. This prospective observational study was conducted over a period of 1 year from May 2017 to April 2018. A total of 105 patients aged 1 year to 17.9 years newly diagnosed as acute lymphoblastic leukemia were the study population. This study showed that in five (33.3%) patients, the underlying cause was suspected intracranial hemorrhage and it was the most common cause. All these five patients had features of severe sepsis and upper motor neuron sign associated with severe thrombocytopenia. Among them three had coagulopathy. Three (20%) patients had CNS leukemic infiltration. Suspected meningitis was attributed as the possible cause of seizure in two (13.33%) patients. Other identifiable causes were brain abscess in one patient, multiple cerebral infarction in one patient, hypertensive encephalopathy in one patient, and vincristine-induced neurotoxicity in one patient. In one patient no identifiable cause was found. Among 15 patients with seizure five (33.3%) patients were improved and completed induction remission chemotherapy. Ten (66.7%) patients died. In this study, we found sepsis and coagulopathy as the major underlying cause of seizure. Outcome was found very dismal in patients who developed seizure.
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Affiliation(s)
- Shahinoor A. Soma
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Nawabganj, Dhaka, Bangladesh
| | - Chowdhury Y. Jamal
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Indira Chowdhury
- Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Chattogram Maa-Sishu O General Hospital, Chattogram, Dhaka, Bangladesh
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11
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McClane J, Chawla A, Welch JJG. Direct CNS administration of rituximab and epratuzumab in a pediatric patient with relapsed refractory CNS B-cell acute lymphoblastic leukemia. Pediatr Blood Cancer 2022; 69:e29664. [PMID: 35293685 DOI: 10.1002/pbc.29664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 01/17/2023]
Abstract
Relapsed central nervous system (CNS) leukemia presents a therapeutic challenge to pediatric oncologists. Systemic monoclonal antibody therapy has shown recent promise in patients with relapsed acute lymphoblastic leukemia, however its effect on CNS disease in this population is not well established. We describe a case of multiply relapsed and refractory CNS leukemia in an adolescent patient who responded to the intra-CNS delivery of rituximab (anti-CD20) and epratuzumab (anti-CD22) therapy, demonstrating the practical use and potential efficacy of a novel route of monoclonal antibody administration in difficult-to-treat CNS leukemia.
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Affiliation(s)
- Jenna McClane
- Department of Pediatrics, Brown University and Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Anjulika Chawla
- Division of Hematology Oncology, Department of Pediatrics, Brown University and Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Jennifer J G Welch
- Division of Hematology Oncology, Department of Pediatrics, Brown University and Hasbro Children's Hospital, Providence, Rhode Island, USA
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12
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Li R, Tang JH, Zhang BB, Shi XY, Dai YY, Qu R. Clinical Analysis of Childhood Acute Lymphoblastic Leukemia With Epilepsy Seizures. Front Neurol 2022; 13:824268. [PMID: 35620787 PMCID: PMC9127044 DOI: 10.3389/fneur.2022.824268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective In order to analyze the clinical characteristics of epileptic seizures in children with acute lymphoblastic leukemia (ALL) during treatment. Methods The clinical and imaging data of children diagnosed as ALL with epilepsy seizures from January 2013 to December 2020 were retrospectively analyzed. Results A total of 2217 children with ALL were admitted during the study, of whom 229 (10.33%) had epileptic seizures after ALL treatment. Among them, 45 (19.65%) were in the high-risk group and 184 (80.35%) were in the low-risk group. Epileptic seizures mainly occurred in the induction remission period (24.02%), maintenance treatment period (25.33%) and after bone marrow transplantation (21.40%). The common causes were MTX-related demyelinating encephalopathy (34.06%) and reversible posterior encephalopathy syndrome (PRES) (25.3%). The first symptom was mainly convulsion (34.50%). The first attack had a comprehensive attack and partial attack. Most patients stop themselves. 30 cases (13.10%) had acute recurrence of epilepsy (recurrence within 3 months after the first attack), and 49 cases (25.76%) had neurological dysfunction after follow-up. 36 cases developed symptomatic epilepsy. Among the 130 children who completed the follow-up, 78 (60.00%) had no obvious neurological sequelae, and 52 (40.0%) had neurological sequelae. Among the 52 cases, there were 34 cases of mild sequelae and 18 cases of severe sequelae, including 8 cases of epilepsy combined with cognitive impairment. Conclusion Epileptic seizure is a common neurological complication during ALL treatment. The etiology and associated manifestations of the first epileptic seizure are diverse. Early neuroimaging and EEG examination are helpful for early diagnosis and treatment.
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Affiliation(s)
- Rui Li
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
- Department of Pediatric, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ji-Hong Tang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Bing-Bing Zhang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Xiao-Yan Shi
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, China
| | - Yuan-Yuan Dai
- Department of Pediatric, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rui Qu
- Department of Pediatric, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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13
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Ranta S, Broman LM, Abrahamsson J, Berner J, Fläring U, Hed Myrberg I, Kalzén H, Karlsson L, Mellgren K, Nilsson A, Norén-Nyström U, Palle J, von Schewelov K, Svahn JE, Törnudd L, Heyman M, Harila-Saari A. ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors. Pediatr Crit Care Med 2021; 22:1050-1060. [PMID: 34074998 DOI: 10.1097/pcc.0000000000002787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Despite progress in the treatment of childhood acute lymphoblastic leukemia, severe complications are common, and the need of supportive care is high. We explored the cumulative prevalence, clinical risk factors, and outcomes of children with acute lymphoblastic leukemia, on first-line leukemia treatment in the ICUs in Sweden. DESIGN A nationwide prospective register and retrospective chart review study. SETTING Children with acute lymphoblastic leukemia were identified, and demographic and clinical data were obtained from the Swedish Childhood Cancer Registry. Data on intensive care were collected from the Swedish Intensive Care Registry. Data on patients with registered ICU admission in the Swedish Childhood Cancer Registry were supplemented through questionnaires to the pediatric oncology centers. PATIENTS All 637 children 0-17.9 years old with acute lymphoblastic leukemia diagnosed between June 2008 and December 2016 in Sweden were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty-eight percent of the children (178/637) were admitted to an ICU at least once. The Swedish Intensive Care Registry data were available for 96% of admissions (241/252). An ICU admission was associated with poor overall survival (hazard ratio, 3.25; 95% CI, 1.97-5.36; p ≤ 0.0001). ICU admissions occurred often during early treatment; 48% (85/178) were admitted to the ICU before the end of the first month of acute lymphoblastic leukemia treatment (induction therapy). Children with T-cell acute lymphoblastic leukemia or CNS leukemia had a higher risk of being admitted to the ICU in multivariable analyses, both for early admissions before the end of induction therapy and for all admissions during the study period. CONCLUSIONS The need for intensive care in children with acute lymphoblastic leukemia, especially for children with T cell acute lymphoblastic leukemia and CNS leukemia, is high with most admissions occurring during early treatment.
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Affiliation(s)
- Susanna Ranta
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Abrahamsson
- Institution of Clinical Sciences, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Berner
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Urban Fläring
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Ida Hed Myrberg
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Kalzén
- Department of Anesthesia, Södertälje Hospital, Södertälje, Sweden
- Department of Anaesthesia and Intensive Care, Karolinska Institutet at Danderyd Hospital (KIDS), Danderyd, Sweden
| | - Lene Karlsson
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Institution of Clinical Sciences, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Anesthesia, Södertälje Hospital, Södertälje, Sweden
- Department of Anaesthesia and Intensive Care, Karolinska Institutet at Danderyd Hospital (KIDS), Danderyd, Sweden
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
- Department of Women's and Children's Health, Uppsala University and Pediatric Oncology, Uppsala University Hospital, Uppsala, Sweden
- Department of Pediatric Oncology, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Pediatrics, Linköping University Hospital, Linköping, Sweden
| | - Karin Mellgren
- Institution of Clinical Sciences, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Nilsson
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Josefine Palle
- Department of Women's and Children's Health, Uppsala University and Pediatric Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Katarina von Schewelov
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan E Svahn
- Department of Pediatric Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lisa Törnudd
- Department of Pediatrics, Linköping University Hospital, Linköping, Sweden
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University and Pediatric Oncology, Uppsala University Hospital, Uppsala, Sweden
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14
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Pharmacogenetics of the Central Nervous System-Toxicity and Relapse Affecting the CNS in Pediatric Acute Lymphoblastic Leukemia. Cancers (Basel) 2021; 13:cancers13102333. [PMID: 34066083 PMCID: PMC8151239 DOI: 10.3390/cancers13102333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Despite recent improvements in cure rates, pediatric acute lymphoblastic leukemia (ALL) patients remain at risk to develop relapse disease or suffer from therapy-associated side effects. Over 5% of adverse events appear in the central nervous system (CNS) and can impact survival or quality of life of the patients. Inherited genetic variations are possible predictive factors for these adverse events. This retrospective study aimed to investigate if inherited genetic variations in genes encoding drug-metabolizing enzymes and drug transporters localized in the blood-brain barrier are predictive for CNS events. Our results suggest that certain ABCB1, ABCG2 and GSTP1 gene polymorphisms influence CNS toxicity and CNS relapse. A more effective drug-clearance could lead to less toxicity but contribute to a higher chance of relapse and vice versa. Genetic variants in ABCB1, ABCG2 or GSTP1 genes are promising candidates for personalized medicine. Abstract Despite improving cure rates in childhood acute lymphoblastic leukemia (ALL), therapeutic side effects and relapse are ongoing challenges. These can also affect the central nervous system (CNS). Our aim was to identify germline gene polymorphisms that influence the risk of CNS events. Sixty single nucleotide polymorphisms (SNPs) in 20 genes were genotyped in a Hungarian non-matched ALL cohort of 36 cases with chemotherapy related acute toxic encephalopathy (ATE) and 544 controls. Five significant SNPs were further analyzed in an extended Austrian-Czech-NOPHO cohort (n = 107 cases, n = 211 controls) but none of the associations could be validated. Overall populations including all nations’ matched cohorts for ATE (n = 426) with seizure subgroup (n = 133) and posterior reversible encephalopathy syndrome (PRES, n = 251) were analyzed, as well. We found that patients with ABCB1 rs1045642, rs1128503 or rs2032582 TT genotypes were more prone to have seizures but those with rs1045642 TT developed PRES less frequently. The same SNPs were also examined in relation to ALL relapse on a case-control matched cohort of 320 patients from all groups. Those with rs1128503 CC or rs2032582 GG genotypes showed higher incidence of CNS relapse. Our results suggest that blood-brain-barrier drug transporter gene-polymorphisms might have an inverse association with seizures and CNS relapse.
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