TY - JOUR
T1 - Seizures during treatment of childhood acute lymphoblastic leukemia
T2 - A population-based cohort study
AU - Anastasopoulou, Stavroula
AU - Heyman, Mats
AU - Eriksson, Mats A
AU - Niinimäki, Riitta
AU - Taskinen, Mervi
AU - Mikkel, Sirje
AU - Vaitkeviciene, Goda E
AU - Johannsdottir, Inga Maria
AU - Myrberg, Ida Hed
AU - Jonsson, Olafur Gisli
AU - Als-Nielsen, Bodil
AU - Schmiegelow, Kjeld
AU - Banerjee, Joanna
AU - Ranta, Susanna
AU - Harila-Saari, Arja
N1 - Copyright © 2020 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - BACKGROUND: Seizures are common in children with acute lymphoblastic leukemia (ALL). As ALL survival rates are improving, the challenge to minimize treatment related side effects and late sequelae rises. Here, we studied the frequency, timing, etiology and risk factors of seizures in ALL patients.METHODS: The study included children aged 1-17.9 years at diagnosis of B-cell-precursor and T cell ALL who were treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol between 2008 and 2015. Detailed patient data were acquired from the NOPHO ALL2008 registry and by review of medical records.RESULTS: Seizures occurred in 81/1464 (5.5%) patients. The cumulative incidence of seizures at one months was 1.7% (95% CI: 1.2-2.5) and at one year 5.3% (95% CI 4.2-6.5%). Patients aged 10-17.9 years, those with T cell immunophenotype, CNS involvement, or high-risk induction with dexamethasone had higher risk for seizures in univariable analyses. Only age remained a risk factor in multivariable analyses (the cumulative incidence of seizures for patients 10-17.9 years old at one year was 9.0% (95% CI: 6.2-12.9)). Of the 81 patients with seizures, 43 had posterior reversible encephalopathy syndrome (PRES), 15 had isolated seizures, nine had sinus venous thrombosis (SVT), three had stroke-like syndrome, and 11 had other neurotoxicities. Epilepsy diagnosis was reported in totally 11 ALL survivors at last follow up.CONCLUSION: Seizures are relatively common in ALL patients and occur most often in patients with PRES, SVT, or as an isolated symptom. Older children have higher risk of seizures.
AB - BACKGROUND: Seizures are common in children with acute lymphoblastic leukemia (ALL). As ALL survival rates are improving, the challenge to minimize treatment related side effects and late sequelae rises. Here, we studied the frequency, timing, etiology and risk factors of seizures in ALL patients.METHODS: The study included children aged 1-17.9 years at diagnosis of B-cell-precursor and T cell ALL who were treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol between 2008 and 2015. Detailed patient data were acquired from the NOPHO ALL2008 registry and by review of medical records.RESULTS: Seizures occurred in 81/1464 (5.5%) patients. The cumulative incidence of seizures at one months was 1.7% (95% CI: 1.2-2.5) and at one year 5.3% (95% CI 4.2-6.5%). Patients aged 10-17.9 years, those with T cell immunophenotype, CNS involvement, or high-risk induction with dexamethasone had higher risk for seizures in univariable analyses. Only age remained a risk factor in multivariable analyses (the cumulative incidence of seizures for patients 10-17.9 years old at one year was 9.0% (95% CI: 6.2-12.9)). Of the 81 patients with seizures, 43 had posterior reversible encephalopathy syndrome (PRES), 15 had isolated seizures, nine had sinus venous thrombosis (SVT), three had stroke-like syndrome, and 11 had other neurotoxicities. Epilepsy diagnosis was reported in totally 11 ALL survivors at last follow up.CONCLUSION: Seizures are relatively common in ALL patients and occur most often in patients with PRES, SVT, or as an isolated symptom. Older children have higher risk of seizures.
KW - Adolescent
KW - Antineoplastic Combined Chemotherapy Protocols/adverse effects
KW - Child
KW - Child, Preschool
KW - Cohort Studies
KW - Female
KW - Humans
KW - Incidence
KW - Infant
KW - Male
KW - Posterior Leukoencephalopathy Syndrome/complications
KW - Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications
KW - Risk Factors
KW - Seizures/epidemiology
KW - Sinus Thrombosis, Intracranial/complications
U2 - 10.1016/j.ejpn.2020.04.004
DO - 10.1016/j.ejpn.2020.04.004
M3 - Journal article
C2 - 32340855
VL - 27
SP - 72
EP - 77
JO - European Journal of Paediatric Neurology
JF - European Journal of Paediatric Neurology
SN - 1090-3798
ER -