Daniele Zama1, Pietro Gasperini1, Massimo Berger2, Mariagrazia Petris3, Maria D De Pasquale4, Simone Cesaro5, Maria E Guerzoni6, Elena Mastrodicasa7, Francesca Savina8, Ottavio Ziino9, Valentina Kiren10, Paola Muggeo11, Rosa M Mura12, Fraia Melchionda1, Giulio A Zanazzo10. 1. Department of Pediatrics, Pediatric Oncology and Haematology Unit "Lalla Seràgnoli", Sant' Orsola Malpighi Hospital, University of Bologna, Bologna, Italy. 2. Pediatric Onco-Hematology and Stem Cell Transplant Division, City of Health and Science, Regina Margherita Children's Hospital, Turin, Italy. 3. Pediatric Hematology-Oncology, Padua, Italy. 4. Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, Rome, Italy. 5. Department of Paediatrics, Paediatric Haematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 6. Department of Medical and Surgical Sciences for Mothers, Children and Adults, Onco-hematology Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy. 7. Pediatric Onco-Hematology and Stem Cell Transplant Unit, S.Maria della Misericordia Hospital, Perugia, Italy. 8. Pediatric Onco-Hematology, Hospital of Parma, Parma, Italy. 9. Pediatric Hematology-Oncology, ARNAS Civico, Palermo, Italy. 10. Pediatric Hematology-Oncology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy. 11. Pediatric Hematology-Oncology, Bari, Italy. 12. Paediatric Haematology-Oncology, Ospedale Pediatrico Microcitemico, Cagliari, Italy.
Abstract
OBJECTIVES: Posterior reversible encephalopathy syndrome (PRES) is one of the most common neurological complications in hematology-oncology pediatric patients. Despite an increasingly recognized occurrence, no clear consensus exists regarding how best to manage the syndrome, because most cases of PRES have reported in single-case reports or small series. Aim of this paper is to identify incidence, clinical features, management, and outcome of PRES in a large series of hematology-oncology pediatric patients. METHODS: The cases of PRES occurred in twelve centers of the Italian Association of Pediatric Hematology and Oncology were reported. RESULTS: One hundred and twenty-four cases of PRES in 112 pediatric patients were recorded with an incidence of 2.1% and 4.7%, respectively, in acute lymphoblastic leukemia in first complete remission and hematopoietic stem cell transplantation (HSCT). The majority of cases occurred after a cycle of chemotherapy rather than after stem cell transplant. PRES after chemotherapy significantly differs from that after HSCT for diagnosis, time of presentation, risk factors, management, and outcome. CONCLUSIONS: This study demonstrates that PRES is a common neurological complication and occurring preferentially in course of induction treatment of some hematologic malignancies, as ALL and after HSCT. It also highlights great clinical differences in the management and outcome in patients with PRES occurring after chemotherapy or after HSCT.
OBJECTIVES: Posterior reversible encephalopathy syndrome (PRES) is one of the most common neurological complications in hematology-oncology pediatric patients. Despite an increasingly recognized occurrence, no clear consensus exists regarding how best to manage the syndrome, because most cases of PRES have reported in single-case reports or small series. Aim of this paper is to identify incidence, clinical features, management, and outcome of PRES in a large series of hematology-oncology pediatric patients. METHODS: The cases of PRES occurred in twelve centers of the Italian Association of Pediatric Hematology and Oncology were reported. RESULTS: One hundred and twenty-four cases of PRES in 112 pediatric patients were recorded with an incidence of 2.1% and 4.7%, respectively, in acute lymphoblastic leukemia in first complete remission and hematopoietic stem cell transplantation (HSCT). The majority of cases occurred after a cycle of chemotherapy rather than after stem cell transplant. PRES after chemotherapy significantly differs from that after HSCT for diagnosis, time of presentation, risk factors, management, and outcome. CONCLUSIONS: This study demonstrates that PRES is a common neurological complication and occurring preferentially in course of induction treatment of some hematologic malignancies, as ALL and after HSCT. It also highlights great clinical differences in the management and outcome in patients with PRES occurring after chemotherapy or after HSCT.
Authors: Redmond-Craig Anderson; Vishal Patel; Nasim Sheikh-Bahaei; Chia Shang J Liu; Anandh G Rajamohan; Mark S Shiroishi; Paul E Kim; John L Go; Alexander Lerner; Jay Acharya Journal: Front Neurol Date: 2020-06-16 Impact factor: 4.003