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Seizures during treatment of childhood acute lymphoblastic leukemia: A population-based cohort study
Stavroula Anastasopoulou1, Mats Heyman1, Mats A Eriksson1
1Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden; Karolinska University Hospital, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Insights
Seizures affect over 5% of children with acute lymphoblastic leukemia (ALL), with older children facing a higher risk. Posterior reversible encephalopathy syndrome (PRES) and sinus venous thrombosis (SVT) are common causes.
Area of Science:
- Pediatric Hematology Oncology
- Pediatric Neurology
- Clinical Research
Background:
- Seizures are a significant concern in pediatric acute lymphoblastic leukemia (ALL) patients.
- Improving ALL survival necessitates addressing treatment-related side effects like seizures.
- Understanding seizure frequency, timing, etiology, and risk factors is crucial.
Purpose of the Study:
- To investigate the incidence, timing, causes, and risk factors of seizures in children with ALL.
- To identify patient subgroups at higher risk for seizure development during ALL treatment.
Main Methods:
- Retrospective analysis of 1464 children (aged 1-17.9 years) diagnosed with ALL between 2008-2015.
- Data sourced from the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 registry and medical records.
- Evaluation of seizure occurrence, associated neurotoxicities, and long-term epilepsy diagnosis.
Main Results:
- Seizures occurred in 5.5% of patients (81/1464).
- Cumulative incidence reached 1.7% at 1 month and 5.3% at 1 year.
- Older age (10-17.9 years) was the primary risk factor in multivariable analysis (9.0% incidence at 1 year).
- Common etiologies included posterior reversible encephalopathy syndrome (PRES) (43/81), isolated seizures (15/81), and sinus venous thrombosis (SVT) (9/81).
- Epilepsy was diagnosed in 11 survivors.
Conclusions:
- Seizures are relatively common in pediatric ALL, particularly in older children.
- PRES and SVT are significant contributors to seizures in this population.
- Identifying high-risk patients can guide preventative strategies and management.
Background:
Seizures are common in children with acute lymphoblastic leukemia (ALL). As ALL survival rates are improving, the challenge to minimize treatment related side effects and late sequelae rises. Here, we studied the frequency, timing, etiology and risk factors of seizures in ALL patients.
Methods:
The study included children aged 1-17.9 years at diagnosis of B-cell-precursor and T cell ALL who were treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol between 2008 and 2015. Detailed patient data were acquired from the NOPHO ALL2008 registry and by review of medical records.
Results:
Seizures occurred in 81/1464 (5.5%) patients. The cumulative incidence of seizures at one months was 1.7% (95% CI: 1.2-2.5) and at one year 5.3% (95% CI 4.2-6.5%). Patients aged 10-17.9 years, those with T cell immunophenotype, CNS involvement, or high-risk induction with dexamethasone had higher risk for seizures in univariable analyses. Only age remained a risk factor in multivariable analyses (the cumulative incidence of seizures for patients 10-17.9 years old at one year was 9.0% (95% CI: 6.2-12.9)). Of the 81 patients with seizures, 43 had posterior reversible encephalopathy syndrome (PRES), 15 had isolated seizures, nine had sinus venous thrombosis (SVT), three had stroke-like syndrome, and 11 had other neurotoxicities. Epilepsy diagnosis was reported in totally 11 ALL survivors at last follow up.
Conclusion:
Seizures are relatively common in ALL patients and occur most often in patients with PRES, SVT, or as an isolated symptom. Older children have higher risk of seizures.
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