Kranjčec Izabela, Rajačić Nada, Janjić Tamara, Kukuruzović Monika, Jadrijević-Cvrlje Filip, Pavlović Maja, Roganović Jelena
Department of Oncology and Hematology, Children's Hospital Zagreb, Klaićeva 16, 10000 Zagreb, Croatia.
General Hospital Karlovac, 47000 Karlovac, Croatia.
Children (Basel). 2024 Dec 28;12(1):31. doi: 10.3390/children12010031.
: Recent advances in childhood acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) management provide higher survival rates at the cost of increased toxicities. Acute neurotoxicity affects up to 10% of patients, requiring rapid recognition and treatment. : A retrospective observational study was performed to determine the frequency, clinical manifestations, radiological characteristics, treatment options and outcome of acute neurological adverse events in pediatric patients with lymphoid malignancies at the Department of Oncology and Hematology, Children's Hospital Zagreb, Croatia. : A total of 56 patients (48 ALL and 8 LL, male/female ratio 1:1, average age 5.4 years) were treated mainly according to the ALL-IC BFM 2009 protocol. The B-immunophenotype was the most frequent (85.7%). Most patients were stratified to the intermediate risk group (39.3%), and two were initially diagnosed with central nervous system infiltration. Acute neurotoxic events were registered in 11 patients (19.6%), most commonly in the 6-10-year age group (66.7%), predominately in females (72.7%) and high-risk group (54.5%). The most frequent clinical presentation was seizures (83.3%), with status epilepticus in four cases. We detected electroencephalogram (EEG) irregularities in almost all patients and various morphological changes in the brain magnetic resonance imaging (MRI), most often consistent with posterior reversible encephalopathy syndrome and leukoencephalopathy. Approximately half the patients received prolonged antiepileptic therapy. No apparent residual neurologic manifestations have been observed. Acute neurotoxicity is a rather frequent treatment-related adverse event, associated with high-risk disease. Early recognition and timely management are essential for rapid recovery and optimal outcomes.
儿童急性淋巴细胞白血病（ALL）和淋巴细胞淋巴瘤（LL）治疗方面的最新进展使生存率提高，但代价是毒性增加。急性神经毒性影响高达10%的患者，需要快速识别和治疗。：在克罗地亚萨格勒布儿童医院肿瘤与血液科进行了一项回顾性观察研究，以确定淋巴系统恶性肿瘤儿科患者急性神经系统不良事件的发生率、临床表现、放射学特征、治疗选择及结局。：共有56例患者（48例ALL和8例LL，男女比例1:1，平均年龄5.4岁）主要按照ALL-IC BFM 2009方案进行治疗。B免疫表型最为常见（85.7%）。大多数患者被分层至中危组（39.3%），2例最初被诊断为中枢神经系统浸润。11例患者（19.6%）出现急性神经毒性事件，最常见于6至10岁年龄组（66.7%），主要为女性（72.7%）和高危组（54.5%）。最常见的临床表现是癫痫发作（83.3%），4例为癫痫持续状态。我们在几乎所有患者中检测到脑电图（EEG）异常以及脑磁共振成像（MRI）中的各种形态学改变，最常与后部可逆性脑病综合征和白质脑病一致。约一半患者接受了延长的抗癫痫治疗。未观察到明显的残留神经表现。急性神经毒性是一种相当常见的与治疗相关的不良事件，与高危疾病相关。早期识别和及时处理对于快速康复和最佳结局至关重要。
