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J Pediatr Hematol Oncol. 2018 Jan;40(1):e13-e18. doi: 10.1097/MPH.0000000000001009.

Posterior Reversible Encephalopathy Syndrome: Risk Factors and Impact on the Outcome in Children With Acute Lymphoblastic Leukemia Treated With Nordic Protocols.

Author information

1
Children's Hospital, University of Helsinki and Helsinki University Hospital, Division of Pediatric Hematology-Oncology and Stem Cell Transplantation.
2
Astrid Lindgren Children's Hospital, Karolinska University Hospital, and the Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
3
Department of Radiology, Helsinki Medical Imaging Center, Helsinki University Hospital.
4
Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku.
5
Department of Pediatrics, Tampere University Hospital, Tampere.
6
Department of Pediatrics, Kuopio University Hospital, Kuopio.
7
PEDEGO Research Unit, Medical Research Center Oulu and Department of Children and Adolescents, Oulu University Hospital and University of Oulu, Oulu, Finland.
8
Division of Child Neurology, Helsinki University Hospital, Helsinki.

Abstract

Posterior reversible encephalopathy syndrome (PRES) in children with acute lymphoblastic leukemia has been increasingly recognized as a clinicoradiological entity. Our aim was to describe the incidence of PRES in pediatric patients with ALL, identify its risk factors, and examine its prognostic importance. For this research, we conducted a systematic, retrospective review of the patient records in a population-based series of children with acute lymphoblastic leukemia (n=643) treated in Finland from 1992 to 2008. Of the patients with ALL, 4.5% (n=29) developed radiologically confirmed PRES, of which 28 cases occurred during induction. Hypertension (P=0.006; odds ratio [OR], 4.10, confidence interval [CI], 1.50-11.25), constipation (P=0.001; OR, 5.60; CI, 2.02-15.52), and >14 days of alkalinization (P=0.017; OR, 3.27; CI, 1.23-8.68) were significant independent risk factors for PRES. One-third of the patients developed epilepsy. Relapses occurred significantly more often in those patients with PRES (P=0.001), which was associated with worse overall survival (P=0.040; 5-year survival=75.9% [60.3%-91.4%] vs. 88.4% [85.8%-90.9%]). Using NOPHO-ALL 92/2000 protocols, PRES is a significant early complication of therapy in ALL, and was associated with a poorer prognosis and significant neurological morbidity.

PMID:
29200159
DOI:
10.1097/MPH.0000000000001009
[Indexed for MEDLINE]

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