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Ocular manifestations in acute lymphoblastic leukemia: A five-year cohort study of pediatric patients

Cristiano de Queiroz Mendonca1, Marcelle Vieira Freire2, Simone Santana Viana3

  • 1Postgraduate Program in Health Sciences, Federal University of Sergipe, Rua Itabaiana 758, Bairro São José, 49.015-110, Aracaju, Sergipe, Brazil.

Leukemia Research
|December 5, 2018
PubMed

Insights

Pediatric acute lymphoblastic leukemia (ALL) patients frequently develop ocular manifestations (OM), particularly ocular hypertension. Those on the 1999 protocol and at high relapse risk show a significantly higher incidence of OM.

Area of Science:

  • Ophthalmology
  • Pediatric Oncology
  • Hematology

Background:

  • Acute lymphoblastic leukemia (ALL) treatment can lead to various complications.
  • Ocular manifestations (OM) in pediatric ALL patients require characterization to understand their impact and associations.

Purpose of the Study:

  • To characterize ocular manifestations (OM) in pediatric patients undergoing treatment for acute lymphoblastic leukemia (ALL).
  • To evaluate the association of OM with predictive risk factors for relapse, treatment protocols (1999 vs. 2009), gender, and cerebrospinal fluid infiltration.

Main Methods:

  • A prospective cohort study included children and adolescents with ALL from January 2013 to December 2017.
  • Ophthalmologic evaluations were performed at multiple time points during treatment.
  • Ocular hypertension (OH) was defined as intraocular pressure >21 mmHg; visual loss (VL) as visual acuity <20/40.

Main Results:

  • Of 55 patients, 18 (32.7%) presented OM, with OH (61.1%), retinal hemorrhage (22.2%), and VL (22.2%) being most common.
  • A strong association was found between OM and high risk of relapse (p=0.035) and the 1999 protocol (p=0.022).
  • Patients on the 1999 protocol had a 2.917 times higher risk of OM.

Conclusions:

  • Pediatric ALL patients exhibit a high incidence of OM, often asymptomatic, which can progress to visual loss.
  • Ocular hypertension is the most prevalent OM in this cohort.
  • The 1999 treatment protocol and high relapse risk are significantly associated with an increased likelihood of developing OM.
Abstract

Keywords:
Acute lymphoblastic leukemiaChemotherapyGlaucomaSteroids

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