A survey on hematology‐oncology pediatric AIEOP centres: The challenge of posterior reversible encephalopathy syndrome

• Published in: European journal of haematology Vol. 100; no. 1; pp. 75 - 82
• Main Authors: Zama, Daniele, Gasperini, Pietro, Berger, Massimo, Petris, Mariagrazia, De Pasquale, Maria D., Cesaro, Simone, Guerzoni, Maria E., Mastrodicasa, Elena, Savina, Francesca, Ziino, Ottavio, Kiren, Valentina, Muggeo, Paola, Mura, Rosa M., Melchionda, Fraia, Zanazzo, Giulio A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2018
• Subjects: Acute lymphoblastic leukemia; Case reports; Chemotherapy; Encephalopathy; Hematology; Hematopoietic stem cells; Lymphatic leukemia; Management; Neurological complications; Oncology; pediatric oncology, and hematology; Pediatrics; posterior reversible encephalopathy syndrome; Remission; Risk factors; Stem cell transplantation; Stem cells; Transplantation; Transplants & implants; posterior reversible encephalopathy syndrome; pediatric oncology, and hematology
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.12984

Objectives Posterior reversible encephalopathy syndrome (PRES) is one of the most common neurological complications in hematology‐oncology pediatric patients. Despite an increasingly recognized occurrence, no clear consensus exists regarding how best to manage the syndrome, because most cases of PRES have reported in single‐case reports or small series. Aim of this paper is to identify incidence, clinical features, management, and outcome of PRES in a large series of hematology‐oncology pediatric patients. Methods The cases of PRES occurred in twelve centers of the Italian Association of Pediatric Hematology and Oncology were reported. Results One hundred and twenty‐four cases of PRES in 112 pediatric patients were recorded with an incidence of 2.1% and 4.7%, respectively, in acute lymphoblastic leukemia in first complete remission and hematopoietic stem cell transplantation (HSCT). The majority of cases occurred after a cycle of chemotherapy rather than after stem cell transplant. PRES after chemotherapy significantly differs from that after HSCT for diagnosis, time of presentation, risk factors, management, and outcome. Conclusions This study demonstrates that PRES is a common neurological complication and occurring preferentially in course of induction treatment of some hematologic malignancies, as ALL and after HSCT. It also highlights great clinical differences in the management and outcome in patients with PRES occurring after chemotherapy or after HSCT.