Incidence and Risk Factors for Hypertension During Childhood Acute Lymphoblastic Leukemia Therapy

Malhotra, Payal; Kapoor, Gauri; Jain, Sandeep; Garg, Bhawna

doi:10.1007/s13312-018-1399-9

Cited by 9 publications

(10 citation statements)

References 11 publications

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“…4 For pediatric patients receiving treatment for ALL, 12-45% of patients who were normotensive before starting ALL therapy developed HTN during induction chemotherapy. [6][7][8][9][10] In a large study of 5578 unique patients receiving induction chemotherapy, 14.7% received anti-HTN medications during their initial hospital admission. 9 This HTN is generally asymptomatic and typically resolves in the majority of patients by day 90 of treatment.…”

Section: Rates Of Hypertensionmentioning

confidence: 99%

Section: Steroid-induced Hypertensionmentioning

confidence: 99%

“… 9 This HTN is generally asymptomatic and typically resolves in the majority of patients by day 90 of treatment. 8 , 10 This wide incidence range may be related to heterogeneity in ALL treatment protocols (with highest incidence rates reported in older regimens when chemotherapy was more frequently combined with radiotherapy), inconsistent categorization of HTN, as well as the variations in patient populations among different studies. 11 Prior to 2017 and version 5.0 of the US National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE), HTN was specified based only on adult HTN definitions which likely contributed to the inconsistent categorization as well as likely underestimated pediatric HTN Table 2 .…”

Section: Introductionmentioning

confidence: 99%

“… 8 Studies have demonstrated decreased odds for developing HTN in those treated with dexamethasone, with its lesser mineralocorticoid potency, compared to prednisone. 9 , 10 There is also evidence for altered hypothalamus–pituitary–adrenal axis functioning in systemic HTN. 14 One study evaluated the genotypes for 203 candidate polymorphisms in genes likely to affect the pharmacokinetics or pharmacodynamics of glucocorticoids and other anti-leukemic agents in childhood ALL patients with HTN.…”

Section: Introductionmentioning

confidence: 99%

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Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies

Murphy

Maloney

Gore

et al. 2022

IBPC

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Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outcomes for many children with ALL, the side effects and consequences of therapy are not to be underestimated. Hypertension is a well-known acute and chronic side effect of treatment for childhood ALL, although limited data are available regarding the prevalence of hypertension in children undergoing treatment for ALL. In this review of hypertension in pediatric ALL patients, we examine the existing data on incidence and prevalence during treatment and in pediatric ALL survivors. We describe independent risk factors for development of hypertension along with treatment-related causes. Long-term consequences and the risk to survivors of pediatric ALL are further defined. While many ALL patients require antihypertensive medications during some portion of their treatment, there are no clear guidelines on treating inpatient hypertension given challenges that exist in recognizing and managing hypertension in this setting and in this population. Here, we propose an algorithmic approach to diagnose and treat pediatric ALL patients with HTN, along with monitoring and continuation versus cessation of antihypertensive therapy as an outpatient.

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Section: Rates Of Hypertensionmentioning

confidence: 99%

Section: Steroid-induced Hypertensionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies

Murphy

Maloney

Gore

et al. 2022

IBPC

View full text Add to dashboard Cite

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“…Hypertension in pediatric ALL patients during treatment is a well-known side-effect, but data on the incidence and prevalence are limited. As the prevalence of hypertension in the healthy pediatric population is approximately 3.5% (82), children and adolescents with ALL develop hypertension in 12-45% during induction therapy (83)(84)(85)(86)(87). Nevertheless, there are no uniform guidelines for the treatment of hypertension during treatment for childhood ALL.…”

Section: Hypertensionmentioning

confidence: 99%

Supportive methods for childhood acute lymphoblastic leukemia then and now: A compilation for clinical practice

et al. 2022

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Survival of childhood acute lymphoblastic leukemia has significantly improved over the past decades. In the early years of chemotherapeutic development, improvement in survival rates could be attained only by increasing the cytostatic dose, also by modulation of the frequency and combination of chemotherapeutic agents associated with severe short- and long-time side-effects and toxicity in a developing child's organism. Years later, new treatment options have yielded promising results through targeted immune and molecular drugs, especially in relapsed and refractory leukemia, and are continuously added to conventional therapy or even replace first-line treatment. Compared to conventional strategies, these new therapies have different side-effects, requiring special supportive measures. Supportive treatment includes the prevention of serious acute and sometimes life-threatening events as well as managing therapy-related long-term side-effects and preemptive treatment of complications and is thus mandatory for successful oncological therapy. Inadequate supportive therapy is still one of the main causes of treatment failure, mortality, poor quality of life, and unsatisfactory long-term outcome in children with acute lymphoblastic leukemia. But nowadays it is a challenge to find a way through the flood of supportive recommendations and guidelines that are available in the literature. Furthermore, the development of new therapies for childhood leukemia has changed the range of supportive methods and must be observed in addition to conventional recommendations. This review aims to provide a clear and recent compilation of the most important supportive methods in the field of childhood leukemia, based on conventional regimes as well as the most promising new therapeutic approaches to date.

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Impact of race/ethnicity and language preferences on pediatric ALL survival outcomes

et al. 2023

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Background: Ethnic and racial disparities have recently been observed both in treatment-related toxicities and rates of long-lasting cure in acute lymphoblastic leukemia (ALL) and acute lymphoblastic lymphoma (ALLy), the most common pediatric malignancy. Despite significant improvements in overall survival in the recent past, a large number of children die from aggressive disease. Methods:We performed a retrospective cohort analysis of 274 pediatric ALL/ ALLy patients within Montefiore Health System from 2004 to 2021 to determine differences in all-cause mortality within the Pediatric Hematologic Malignancies Cohort using Cox Proportional Hazard regression modeling, adjusted for age at diagnosis, race/ethnicity, administration of intensive chemotherapy, preferred language, maximum glucose, and hypertension.Results: Among our 274 patients, 132 were Hispanic, 54 Non-Hispanic Black, and 25 Non-Hispanic White, with 25 identified as "Non-Hispanic Other," including Asian, Arabic, and Other. Hispanic patients were 78% less likely to die (HR 0.22; 95% CI 0.07, 0.73) when compared with Non-Hispanic Black individuals. Spanish speakers were 2.91 times more likely to die compared with those who spoke English (HR 2.91; 95% CI 1.08, 7.82). Among those English speakers, the diagnosis of hypertension and Hispanic ethnicity significantly impacted the risk of death, while these factors did not impact survival in Spanish speakers. Highrisk cytogenetics did not impact survival.Conclusions: Hispanic children with ALL/ALLy have improved survival outcomes compared with Non-Hispanic Blacks. Additionally, Spanish language preference was strongly associated with poorer survival, a novel finding that should be validated in future studies.

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Incidence and Risk Factors for Hypertension During Childhood Acute Lymphoblastic Leukemia Therapy

Cited by 9 publications

References 11 publications

Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies

Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies

Supportive methods for childhood acute lymphoblastic leukemia then and now: A compilation for clinical practice

Impact of race/ethnicity and language preferences on pediatric ALL survival outcomes

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