Posterior Reversible Encephalopathy Syndrome in Children with Malignancies or After Hematopoietic Cell...

Area of Science:

• Pediatric Hematology Oncology
• Neuroscience
• Transplant Medicine

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a neurological complication observed in children undergoing cancer treatment or hematopoietic cell transplantation (HCT).
• Understanding the clinical and laboratory characteristics, management, and outcomes of PRES in this vulnerable population is crucial for improving patient care.

Purpose of the Study:

• To analyze the clinical and laboratory features of PRES in pediatric patients with malignancies or post-HCT.
• To evaluate the management, outcomes, and complications associated with PRES in this cohort.
• To identify factors influencing survival and propose revised diagnostic parameters for PRES.

Main Methods:

• A multicenter retrospective analysis of PRES episodes in Polish pediatric hematology and oncology (PHO) centers and HCT units between 2014 and 2022.
• Inclusion of 438 patients: 120 diagnosed with PRES and 318 controls.
• Comparison of clinical presentation, laboratory findings, ICU admission rates, long-term complications, and survival (DFS and OS) between groups.

Main Results:

• PRES occurred in children aged 1.7-16.5 years, most commonly associated with acute lymphoblastic leukemia (ALL).
• Key symptoms included consciousness disturbances, seizures, hypertension, and electrolyte abnormalities (hyponatremia, hypokalemia).
• PRES patients had higher ICU admission rates and worse long-term outcomes, including significantly lower disease-free survival (DFS) and overall survival (OS) in both PHO and HCT groups.

Conclusions:

• PRES is a significant complication in pediatric oncology and HCT, associated with poorer survival.
• The study identified key clinical and laboratory predictors of PRES.
• Revised diagnostic criteria and a predictive index for PRES were proposed, along with a potential renaming of the syndrome.