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Published on: October 17, 2025
Incidence of Hypertension During Induction Therapy in Children with Acute Lymphoblastic Leukemia
Yamini Karanam1, Amita Trehan1, Deepak Bansal2
1Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Systematic blood pressure monitoring during induction therapy for childhood acute lymphoblastic leukemia (ALL) revealed a 58.7% hypertension incidence, primarily in the first two weeks. Regular monitoring is crucial for early detection and management.
Area of Science:
- Pediatric Oncology
- Cardiovascular Health in Children
- Hematology
Background:
- Hypertension is a potential complication during induction therapy for childhood acute lymphoblastic leukemia (ALL).
- The incidence and timing of hypertension during ALL induction therapy are not well-characterized due to inconsistent blood pressure monitoring.
- Early detection of hypertension is vital to prevent associated complications.
Purpose of the Study:
- To estimate the incidence of hypertension in children undergoing induction therapy for ALL.
- To compare hypertension rates between a prospectively monitored cohort and a retrospectively analyzed cohort.
- To identify the timing of hypertension onset during induction therapy.
Main Methods:
- An ambispective observational study comparing two cohorts of children with ALL.
- Prospective cohort: 46 children with weekly blood pressure monitoring using auscultatory method.
- Retrospective cohort: 160 children with review of case files for incidentally detected hypertension or PRES.
Main Results:
- Hypertension incidence was significantly higher in the prospective cohort (58.7%) versus the retrospective cohort (12.5%) (P < 0.001).
- Most hypertension cases (92.6%) in the prospective cohort occurred within the first two weeks of induction.
- Posterior reversible encephalopathy syndrome (PRES) was rare, with 0 cases in the prospective and 2 cases in the retrospective cohort.
Conclusions:
- The incidence of hypertension during childhood ALL induction therapy is substantial (58.7%), with a peak in the initial two weeks.
- Systematic blood pressure monitoring is essential for early identification of hypertension in children receiving ALL induction chemotherapy.
- Routine blood pressure assessment should be integrated into the care of pediatric ALL patients during induction therapy.
Objective:
To estimate the incidence of hypertension during induction therapy in children with acute lymphoblastic leukemia (ALL), comparing a systematically monitored prospective cohort to a retrospective cohort lacking regular blood pressure monitoring.
Methods:
This ambispective observational study was conducted at a pediatric hematology-oncology unit in Chandigarh, India. The prospective cohort included 46 children with B-/T-ALL or T-cell non-Hodgkin lymphoma enrolled between September 2023 and August 2024, whose blood pressure was monitored weekly during induction therapy using the auscultatory method with an aneroid sphygmomanometer. Hypertension was defined according to the 2017 American Academy of Pediatrics guidelines. The retrospective cohort comprised 160 children diagnosed between June 2022 and July 2023, whose case files were reviewed for documented hypertension or posterior reversible encephalopathy syndrome (PRES). In the retrospective cohort, blood pressure was not monitored systematically and was detected incidentally during routine care or at the time of admission for intercurrent illnesses.
Results:
Hypertension was observed in 27 (58.7%) patients in the prospective cohort, compared to 20 (12.5%) in the retrospective (P < 0.001). Most (92.6%) cases of hypertension in the prospective cohort occurred within the first two weeks of induction. No case vs. two (1.3%) cases of PRES were reported in the prospective and retrospective cohorts.
Conclusion:
The incidence of hypertension during induction therapy in childhood ALL was 58.7%, with most cases occurring within the first two weeks. Incorporating blood pressure monitoring into routine care is essential for children with ALL receiving induction chemotherapy.
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