Pattern and Outcome of Neurological Complications During the Treatment of Pediatric Acute Leukemias in Upper Egypt

H. Sayed, Radwa R Hussein, Haisam Atta, M. Abdelhamed, A. Shibl
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Abstract

Background: Despite the treatment progress of acute leukemias, neurological complications (NCs) can occur and may have a detrimental impact on the outcome. Aim: To study the pattern and outcome of NCs occurring during treatment of pediatric acute leukemias in Upper Egypt and to study possible factors influencing their outcomes. Methods: Children with AL who developed NCs during treatment were included. Patients with central nervous system (CNS) infiltration at diagnosis and those with any neurological insults before diagnosis were excluded. Data were retrospectively collected from patient files and included NCs, their outcome, and possible associated factors. Results: Neurological complications occurred in 89 out of 537 (16.6%) reviewed patients. Age was ≥ 10 years in 47.2% of patients, acute lymphoblastic leukemia was the most common diagnosis (77.5%) and the majority (77.9%) were classified as high-risk. Almost half of the patients suffered from NCs during the induction phase of treatment. Motor deficits and seizures were the most frequent manifestations. Neurovascular causes and peripheral neuropathy constituted 27% and 21.3% of the etiology. Other causes included CNS relapse (19.1%), seizures due to systemic causes (13.5%), CNS infections (12.4%), and leukoencephalopathy (6.7%). The treatment phase and recovery time differed significantly according to the type of NCs. The outcome of NCs was complete recovery in 67.4% of the patients, incomplete recovery in 7.9%, and no recovery and death in 24.7%. The etiology of NCs was the only factor that had a significant correlation with the outcome of the patients. Conclusions: Neurological complications during treatment occur in a significant proportion of pediatric patients with acute leukemia in South Egypt. Neurovascular causes and peripheral neuropathy are the most common NCs, and CNS hemorrhage is the most fatal. Supportive measures for these NCs must be optimized to improve outcome.
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上埃及儿童急性白血病治疗过程中神经系统并发症的模式和结果
背景:尽管急性白血病的治疗取得了进展,但神经系统并发症(nc)仍可能发生,并可能对治疗结果产生不利影响。目的:研究上埃及地区儿童急性白血病治疗过程中发生的NCs的模式和结局,并探讨影响其结局的可能因素。方法:纳入在治疗过程中发生nc的AL患儿。排除诊断时有中枢神经系统(CNS)浸润及诊断前有神经损伤的患者。从患者档案中回顾性收集数据,包括nc、其结果和可能的相关因素。结果:537例患者中有89例(16.6%)出现神经系统并发症。年龄≥10岁的患者占47.2%,急性淋巴细胞白血病是最常见的诊断(77.5%),大多数(77.9%)被归为高危。在治疗的诱导阶段,几乎一半的患者患有神经细胞癌。运动障碍和癫痫是最常见的表现。神经血管病因和周围神经病变分别占27%和21.3%。其他原因包括中枢神经系统复发(19.1%)、全身性原因引起的癫痫发作(13.5%)、中枢神经系统感染(12.4%)和脑白质病(6.7%)。不同nc类型的治疗期和恢复时间有显著差异。NCs的结果为67.4%的患者完全恢复,7.9%的患者不完全恢复,24.7%的患者无恢复和死亡。NCs的病因是唯一与患者预后有显著相关性的因素。结论:在治疗过程中神经系统并发症发生在南埃及急性白血病儿童患者的显著比例。神经血管原因和周围神经病变是最常见的nc,而中枢神经系统出血是最致命的。必须优化对这些国家的支持措施,以改善结果。
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审稿时长
8 weeks
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