Posterior Reversible Encephalopathy Syndrome: Incidence and Clinical Characteristics in Children With Cancer

Area of Science:

• Pediatric Oncology
• Neurology
• Hematology

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological condition with poorly understood causes and outcomes in pediatric cancer patients.
• Understanding incidence, risk factors, and outcomes is crucial for managing this vulnerable population.

Purpose of the Study:

• Determine the incidence of PRES in children with cancer.
• Identify risk factors, including age, diagnosis, comorbidities, and chemotherapy agents.
• Describe the associated morbidity and mortality.

Main Methods:

• Retrospective screening of 473 children with hematologic malignancy or post-allogeneic hematopoietic cell transplantation (HCT).
• Case-control study matching PRES patients with two controls based on age and diagnosis.
• Analysis of comorbidities and chemotherapeutic agents, including Etoposide, steroids, and calcineurin inhibitors.

Main Results:

• Fourteen patients developed PRES, with an incidence of 5.9 per 1000 person-years.
• Hematopoietic cell transplantation and Etoposide use were significantly associated with PRES development.
• PRES was linked to high morbidity, including ICU admissions, and a 29% hospital mortality rate from secondary causes.

Conclusions:

• PRES is an infrequent but severe complication in pediatric cancer patients, particularly those undergoing HCT.
• Etoposide is a potential risk factor, while comorbidities, steroids, and calcineurin inhibitors were not associated in this study.
• The high morbidity and mortality underscore the need for vigilance and further research into PRES prevention and management in this population.