Neurotoxicity in children who receive treatment for acute lymphoblastic leukemia

This study aimed to investigate neurotoxicity (side effects involving the brain or nervous system) as a side effect in children who were treated for acute lymphoblastic leukemia.

This study concluded that neurotoxicity is a rare side effect that mainly occurs in the induction phase of treatment for this group of patients.

80% of children with acute lymphoblastic leukemia (ALL) will survive with the current treatments available. Neurotoxicity is a rare side effect of ALL treatments. It occurs when the treatment has an unwanted effect on the central or peripheral nervous system. Examples of some ALL treatments include methotrexate (Trexall), L-asparaginase (Elspar), vincristine (Marqibo) and corticosteroids. Methotrexate, L-asparaginase and vincristine are chemotherapies. Corticosteroids are used to help manage symptoms of cancer such as inflammation.

The frequency, time of occurrence and most common symptoms of neurotoxicity were unknown in children with treated ALL.  

This study involved 1379 patients aged 0 to 16 years who had ALL and received treatment. 3.6% of all patients involved experienced neurotoxicity. 55% of cases of neurotoxicity occurred during the induction phase of treatment.

Methotrexate-leukoencephalopathy (involving the white matter of the brain) was seen in 35.4% of patients. Cerebral-venous-sinus thrombosis (blood clot) following L-asparaginase treatment was seen in 26.5%. Vincristine-induced-vocal-cord paralysis was seen in 14.2%. 14% had stroke-associated vasospasm (sudden narrowing of a blood vessel) after high-dose methotrexate. 6.1% had severe polyneuropathy (degeneration of nerves through the body). 2% had methotrexate myelopathy (loss of spinal cord function). 2% had pseudotumor-cerebri (increased pressure) associated with corticosteroid therapy.

Symptoms of neurotoxicity that patients experienced included headaches, confusion and seizures. Seizures were the initial symptom in 42.8% of cases.

This study concluded that neurotoxicity is a rare side effect of ALL treatment and occurs mainly during induction. This study also concluded that MLE was the most frequent type of neurotoxicity and seizures are the most common first symptom of neurotoxicity.

Consult your physician about the possible side effects of treatment regimens for ALL.