Leukoencephalopathy after CNS prophylaxis for acute lymphoblastic leukaemia

Area of Science:

• Neuroscience
• Pediatric Oncology
• Neurology

Background:

• A 16-year-old male presented with a history of epilepsy and learning difficulties.
• He was diagnosed with acute lymphoblastic leukemia (ALL) at age 3 and treated with the UKALL VIII protocol, including central nervous system (CNS) prophylaxis (radiotherapy and chemotherapy).

Observation:

• Following leukemia remission, the patient developed lethargy, handwriting difficulties, concentration deficits, and memory problems starting at age 7.
• He experienced atypical absence seizures, exacerbated by concentration and fatigue, with EEG showing bilateral abnormalities and epileptiform features.
• Despite 9 years of various anti-epileptic drug trials, seizures relapsed, and at age 13, MRI revealed subcortical white matter lesions.

Findings:

• The patient exhibits persistent neurological sequelae, including intractable epilepsy and cognitive impairment.
• Brain MRI revealed multiple small high-intensity lesions in the subcortical white matter, suggesting potential treatment-related white matter damage.
• The combination of CNS radiotherapy and chemotherapy in ALL treatment may be associated with long-term neurodevelopmental and neurological complications.

Implications:

• This case highlights the potential for delayed-onset neurological and cognitive deficits following childhood leukemia treatment.
• Further research is needed to understand the mechanisms of treatment-induced neurotoxicity and to develop strategies for prevention and management.
• Long-term neurocognitive and neurological monitoring is crucial for survivors of childhood leukemia treated with CNS-directed therapies.