Neurological complications of childhood leukemia

Abstract

As the prognosis of children with acute lymphoblastic leukemia (ALL) improves the complications of management assume greater importance. Among the most serious problems are neurological complications, which may cause permanent disability in children with prolonged leukemia-free survival. As treatment of the acute myeloid leukemias (AML) improves, a similar range of problems may be encountered. The authors have reviewed the neurological complications not directly attributable to leukemic infiltration in a group of 438 children with leukemia or lymphoma. 61 children had one or more complications due chiefly to bleeding, infection, or drug toxicity. Early death from intracranial hemorrhage occurred in 1% of children with lymphoblastic leukemia and 7% of children with myeloblastic leukemia. Measles and chicken pox were the most serious infective complications; 1 child remains severely retarded after presumed measles encephalitis, 1 child with chicken pox died, and a second remains disabled. 2 additional cases of measles encephalitis and 1 of progressive multifocal leucoencephalopathy are described. Drugs which caused neurotoxicity included vincristine, cytosine arabinoside, L-asparaginase, and phenothiazines, but most problems were caused by methotrexate. Methotrexate toxicity was more prevalent and more serious in children, who had had previous central nervous system leukemia. The authors conclude that viral infections and methotrexate pose the greatest neurological hazards to children with leukemia.