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Severe permanent encephalopathy in acute lymphoblastic leukemia
B L Maria1, M Dennis, M Obonsawin
1Department of Pediatrics, University of Florida College of Medicine, Gainesville 32610.
Insights
Childhood acute lymphoblastic leukemia survivors may face long-term neurological issues. Acute encephalopathy during chemotherapy can lead to persistent seizures and cognitive impairment, even after treatment stops.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Childhood Leukemia
Background:
- Increasing survival rates in childhood acute lymphoblastic leukemia (ALL) necessitate a focus on long-term quality-of-life.
- While acute neurotoxicity is known, late neurological sequelae are considered rare in ALL survivors.
Observation:
- Three boys with newly-diagnosed ALL developed obtundation and severe seizures during late induction chemotherapy.
- They received a standard four-drug chemotherapy regimen.
Findings:
- Despite being disease-free survivors, all three developed persistent, intractable partial complex seizures.
- They also exhibited broad neuropsychological impairment and significant neuroimaging abnormalities.
Implications:
- Children experiencing acute encephalopathy during ALL induction chemotherapy are at risk for long-term neurological deficits.
- These risks persist even when neurotoxic therapies are discontinued.
- This highlights the need for vigilant neurological monitoring in pediatric leukemia patients.
Abstract:
As survival rates for childhood acute lymphoblastic leukemia have increased, concerns over improved quality-of-life have also increased. Although 3-10% of children may experience acute transient neurotoxicity during induction chemotherapy, they are felt to be at low risk for late sequelae. We report three previously healthy boys with newly-diagnosed acute lymphoblastic leukemia who presented with obtundation and severe seizures during late induction with a standard four drug chemotherapy regimen. While all three are disease-free survivors, they unexpectedly have persistent and medically intractable partial complex seizures, broad-based neuropsychological impairment and striking neuroimaging abnormalities. These findings suggest that children with leukemia who develop an acute encephalopathy during induction chemotherapy are at risk for long-term neurological and neuropsychological sequelae, despite the cessation of further potentially neurotoxic therapy.