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

Stavroula Anastasopoulou; Arja Harila-Saari; Bodil Als-Nielsen; Mats Anders Eriksson; Mats Heyman; Inga Maria Johannsdottir; Hanne Vibeke Marquart; Riitta Niinimäki; Cornelis Jan Pronk; Kjeld Schmiegelow; Goda Vaitkeviciene; Maria Thastrup; Susanna Ranta

doi:10.1002/pbc.29745

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

Pediatr Blood Cancer. 2022 Jul;69(7):e29745. doi: 10.1002/pbc.29745. Epub 2022 Apr 30.

Authors

Stavroula Anastasopoulou^{1

2}, Arja Harila-Saari³, Bodil Als-Nielsen⁴, Mats Anders Eriksson^{1

5}, Mats Heyman^{1

2}, Inga Maria Johannsdottir⁶, Hanne Vibeke Marquart⁷, Riitta Niinimäki⁸, Cornelis Jan Pronk⁹, Kjeld Schmiegelow^{4

10}, Goda Vaitkeviciene¹¹, Maria Thastrup⁴, Susanna Ranta^{1

2}

Affiliations

¹ Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
² Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.
³ Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
⁴ Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
⁵ Department of Women's and Children's Health, Neuropediatric Unit, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Pediatric Hematology/Oncology, Oslo University Hospital, Oslo, Norway.
⁷ Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
⁸ Department of Children and Adolescents, Oulu University Hospital and University of Oulu, PEDEGO Research Unit, Oulu, Finland.
⁹ Childhood Cancer Centre, Skåne University Hospital, Lund, Sweden.
¹⁰ Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.
¹¹ Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania.

PMID: 35488712
DOI: 10.1002/pbc.29745

Abstract

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, and PRES in univariate analysis and, after adjusting for induction therapy, for seizures (hazard ratio [HR] = 3.33; 95% confidence interval [CI]: 1.26-8.82; p = 0.016) and PRES (HR = 4.85; 95% CI: 1.71-13.75; p = 0.003).

Keywords: CNS leukemia; CNS toxicity; flow cytometric immunophenotyping; pediatric acute lymphoblastic leukemia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Central Nervous System
Central Nervous System Neoplasms* / drug therapy
Child
Flow Cytometry
Humans
Posterior Leukoencephalopathy Syndrome*
Precursor Cell Lymphoblastic Leukemia-Lymphoma* / drug therapy
Seizures