Seizures during treatment of childhood acute lymphoblastic leukemia: A population-based cohort study

Anastasopoulou, Stavroula; Heyman, Mats; Eriksson, Mats; Niinimäki, Riitta; Taskinen, Mervi; Mikkel, Sirje; Vaitkevičienė, Goda; Johannsdottir, Inga Maria; Myrberg, Ida Hed; Jónsson, Òlafur G.; Als‐Nielsen, Bodil; Schmiegelow, Kjeld; Banerjee, Joanna; Ranta, Susanna; Harila‐Saari, Arja

doi:10.1016/j.ejpn.2020.04.004

Cited by 21 publications

(37 citation statements)

References 43 publications

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“…In our study, patients with T-cell ALL and CNS leukemia had higher risk for admission to the ICU, but we could not show association with higher ICU mortality. CNS leukemia and T-cell immunophenotype have been associated with acute CNS toxicity, increased need for intensive care, and thrombosis (23)(24)(25)(26). A previous Nordic study showed that patients with T-cell ALL had higher risk for treatment-related mortality, but this could not be demonstrated in another large study from the United States (5,27).…”

Section: At the Bedsidementioning

confidence: 99%

ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors

Ranta

Broman

Abrahamsson

et al. 2021

Pediatric Critical Care Medicine

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OBJECTIVES: Despite progress in the treatment of childhood acute lymphoblastic leukemia, severe complications are common, and the need of supportive care is high. We explored the cumulative prevalence, clinical risk factors, and outcomes of children with acute lymphoblastic leukemia, on first-line leukemia treatment in the ICUs in Sweden. DESIGN:A nationwide prospective register and retrospective chart review study. SETTING:Children with acute lymphoblastic leukemia were identified,and demographic and clinical data were obtained from the Swedish Childhood Cancer Registry. Data on intensive care were collected from the Swedish Intensive Care Registry. Data on patients with registered ICU admission in the Swedish Childhood Cancer Registry were supplemented through questionnaires to the pediatric oncology centers. PATIENTS:All 637 children 0-17.9 years old with acute lymphoblastic leukemia diagnosed between June 2008 and December 2016 in Sweden were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Twenty-eight percent of the children (178/637) were admitted to an ICU at least once. The Swedish Intensive Care Registry data were available for 96% of admissions (241/252). An ICU admission was associated with poor overall survival (hazard ratio, 3.25; 95% CI, 1.97-5.36; p ≤ 0.0001). ICU admissions occurred often during early treatment; 48% (85/178) were admitted to the ICU before the end of the first month of acute lymphoblastic leukemia treatment (induction therapy). Children with T-cell acute lymphoblastic leukemia or CNS leukemia had a higher risk of being admitted to the ICU in multivariable analyses, both for early admissions before the end of induction therapy and for all admissions during the study period. CONCLUSIONS:The need for intensive care in children with acute lymphoblastic leukemia, especially for children with T cell acute lymphoblastic leukemia and CNS leukemia, is high with most admissions occurring during early treatment.

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Section: At the Bedsidementioning

confidence: 99%

ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors

Ranta

Broman

Abrahamsson

et al. 2021

Pediatric Critical Care Medicine

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“…According to statistics, epileptic seizures occurred in 8 ~ 13% of ALL patients during treatment ( 6 ). There is a higher risk of late neurological complications in ALL patients with epilepsy than those without epilepsy, leading to symptomatic epilepsy and mental retardation ( 7 ). It is not only beneficial to timely and effective treatment and avoid irreversible damage, but also affects the choice of follow-up chemotherapy and the prognosis of nervous system in children with ALL.…”

Section: Introductionmentioning

confidence: 99%

Clinical Analysis of Childhood Acute Lymphoblastic Leukemia With Epilepsy Seizures

Tang

Zhang

et al. 2022

Front. Neurol.

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ObjectiveIn order to analyze the clinical characteristics of epileptic seizures in children with acute lymphoblastic leukemia (ALL) during treatment.MethodsThe clinical and imaging data of children diagnosed as ALL with epilepsy seizures from January 2013 to December 2020 were retrospectively analyzed.ResultsA total of 2217 children with ALL were admitted during the study, of whom 229 (10.33%) had epileptic seizures after ALL treatment. Among them, 45 (19.65%) were in the high-risk group and 184 (80.35%) were in the low-risk group. Epileptic seizures mainly occurred in the induction remission period (24.02%), maintenance treatment period (25.33%) and after bone marrow transplantation (21.40%). The common causes were MTX-related demyelinating encephalopathy (34.06%) and reversible posterior encephalopathy syndrome (PRES) (25.3%). The first symptom was mainly convulsion (34.50%). The first attack had a comprehensive attack and partial attack. Most patients stop themselves. 30 cases (13.10%) had acute recurrence of epilepsy (recurrence within 3 months after the first attack), and 49 cases (25.76%) had neurological dysfunction after follow-up. 36 cases developed symptomatic epilepsy. Among the 130 children who completed the follow-up, 78 (60.00%) had no obvious neurological sequelae, and 52 (40.0%) had neurological sequelae. Among the 52 cases, there were 34 cases of mild sequelae and 18 cases of severe sequelae, including 8 cases of epilepsy combined with cognitive impairment.ConclusionEpileptic seizure is a common neurological complication during ALL treatment. The etiology and associated manifestations of the first epileptic seizure are diverse. Early neuroimaging and EEG examination are helpful for early diagnosis and treatment.

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“…Children aged between 1 and 17.9 years, diagnosed with ALL between Patients with data on CSF by FCI at diagnosis were identified from a previous study and combined with registry data. 4,7,10 Patients with ≥10 blasts in the CSF by FCI were defined as having CNS involvement (CNS flow+ ) and patients with <10 blasts in the CSF were defined as not having CNS involvement (CNS flow-). 4 Statistical analyses were performed using SPSS, version 26.0.…”

Section: Methodsmentioning

confidence: 99%

“…Children aged between 1 and 17.9 years, diagnosed with ALL between 2008 and 2015 and treated according to the Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL2008 protocol, with data from diagnostic lumbar puncture by both CSF FCI and CM, were included. Patients with CNS toxicities were identified through a prospective online registration system 1,7,10 . CNS toxicities were grouped into three categories: “all CNS toxicities” including patients with any CNS toxicity, “seizures” including patients with isolated seizures and those with seizures secondary to other CNS toxicity, and “PRES.”…”

Section: Methodsmentioning

confidence: 99%

Does minimal central nervous system involvement in childhood acute lymphoblastic leukemia increase the risk for central nervous system toxicity?

Anastasopoulou

Harila‐Saari

Als‐Nielsen

et al. 2022

Pediatric Blood & Cancer

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Central nervous system (CNS) involvement in childhood acute lymphoblastic leukemia (ALL) implicates enhanced intrathecal chemotherapy, which is related to CNS toxicity. Whether CNS involvement alone contributes to CNS toxicity remains unclear.We studied the occurrence of all CNS toxicities, seizures, and posterior reversible encephalopathy syndrome (PRES) in children with ALL without enhanced intrathecal chemotherapy with CNS involvement (n = 64) or without CNS involvement (n = 256) by flow cytometry. CNS involvement increased the risk for all CNS toxicities, seizures,

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Seizures during treatment of childhood acute lymphoblastic leukemia: A population-based cohort study

Cited by 21 publications

References 43 publications

ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors

ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors

Clinical Analysis of Childhood Acute Lymphoblastic Leukemia With Epilepsy Seizures

Does minimal central nervous system involvement in childhood acute lymphoblastic leukemia increase the risk for central nervous system toxicity?

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