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High incidence of hypertension in children presenting with acute lymphoblastic leukemia
S P Attard-Montalto1, V Saha, Y Y Ng
1Department of Paediatric Oncology, St Bartholomew's Hospital, London, United Kingdom.
Insights
Hypertension is common in children with acute lymphoblastic leukemia (ALL), affecting 46% of patients at diagnosis or during treatment. Prompt management of high blood pressure in ALL patients is crucial to prevent serious complications.
Area of Science:
- Pediatric Oncology
- Nephrology
- Hematology
Background:
- Hypertension is a known complication of acute lymphoblastic leukemia (ALL), but its incidence and clinical significance in pediatric ALL are not well-established.
- Understanding the prevalence and characteristics of hypertension in pediatric ALL is essential for optimizing patient care and preventing adverse outcomes.
Purpose of the Study:
- To determine the incidence of hypertension in newly diagnosed pediatric patients with acute lymphoblastic leukemia (ALL).
- To investigate the clinical presentation, management, and outcomes of hypertension in this patient population.
- To explore the association between hypertension, renal abnormalities, and the leukemic process.
Main Methods:
- Retrospective review of blood pressure profiles in 30 newly diagnosed pediatric ALL patients over 18 months.
- Assessment of hypertension at presentation and during induction chemotherapy.
- Correlation of hypertension with renal ultrasound findings and clinical symptoms.
- Monitoring of blood pressure during follow-up after chemotherapy.
Main Results:
- 46% (14 of 30) of pediatric ALL patients exhibited hypertension at presentation or during induction chemotherapy.
- Hypertension was often asymptomatic, though one patient experienced generalized convulsions.
- Four hypertensive patients showed renal enlargement on ultrasound, which resolved with hematologic remission.
- All hypertensive patients achieved normotension at follow-up (2-18 months post-chemotherapy).
Conclusions:
- The high incidence of hypertension in pediatric ALL suggests the leukemic process is a significant etiologic factor.
- Chemotherapy can aggravate or unmask pre-existing hypertension in ALL patients.
- Increased awareness and timely management of hypertension are vital to mitigate potential life-threatening complications in pediatric ALL.
Abstract:
Although hypertension is a complication of acute lymphoblastic leukemia (ALL), its true incidence in this disease is unknown. In this study the blood pressure profiles in all children newly diagnosed with ALL were reviewed over an 18-month period. Fourteen (46%) from a total of 30 patients were found to be hypertensive at presentation (n = 8) or during induction chemotherapy (n = 6). A patient with significant hypertension developed generalized convulsions; the rest were asymptomatic. Six patients were managed with antihypertensive drugs. Four patients with hypertension had renal enlargement on the initial ultrasound scan, which returned to normal when hematologic remission was achieved. One patient without hypertension had bilateral renal enlargement, but this persisted despite achieving remission. All patients with hypertension were normotensive at follow-up 2 to 18 months after induction chemotherapy. The presence of hypertension before therapy and its association with renal enlargement suggest that the leukemic process is an important etiologic factor. In all cases therapy aggravated or unmasked the elevation in blood pressure. Considering the high incidence of susceptible patients, increased awareness and prompt management may avoid possible life-threatening complications.