All issues > Volume 46(6); 2003

Original Article

J Korean Pediatr Soc. 2003;46(6):566-571. Published online June 15, 2003.

Leukoencephalopathy after CNS Prophylactic Therapy in Pediatric Hematologic Malignancy

Jun Hwa JH Lee¹, Sun Min SM Lee², Eun Jin EJ Choi¹, Kun Soo KS Lee²

¹Department of Pediatrics, The Catholic University of Korea, School of Medicine, Daegu, Korea
²Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence Kun Soo KS Lee ,Email: kslee@knu.ac.kr

Abstract

Purpose
: Leukoencephalopathy(LE) is one of the most serious complications in children with hematologic malignancies during the course of treatment. Early recognition is important to reduce the impact and sequelae from LE. We therefore investigated the clinical features of LE following central nervous system(CNS) prophylaxis in children with hematologic malignancies and evaluated the significance of regular check-ups of brain MRI.
Methods
: We retrospectively reviewed children with hematologic malignancies who had CNS prophylaxis including intrathecal(IT) methotrexate(MTX) and/or cranial irradiation at the Department of Pediatrics, Kyungpook National University Hospital from Oct. 1995 to May 2002. Fifteen cases of acute leukemia and one case of lymphoma who experienced LE following CNS prophylaxis were included in the study. Clinical data were analyzed from the medical records and brain MRIs were reviewed by neuroradiologists.
Results
: The ages ranged from 1 to 13 years(median age=5.2 years), and the male to female ratio was 3 : 1. The time interval from the beginning of chemotherapy to the time of diagnosis of LE ranged from 2 to 17 months. They all had IT MTX two to 15 times and ten underwent cranial irradiation(1,800 rads). At the time of diagnosis, ten of them had neuropsychiatric symptoms including seizures, personality changes, headache, etc. After the change of treatment modality, four cases showed significant improvement on follow-up MRIs, six cases had no significant changes and two had worsening of LE. Four patients died of infection and bone marrow relapse.
Conclusion
: CNS prophylaxis with IT therapy and cranial irradiation may cause leukoencephalopathy during the course of treatment. As a result, regular brain MRI check-up is recommended for the early detection and reducing the incidence of LE, along with changes in the treatment modality.

Keywords :Leukoencephalopathy, CNS prophylactic therapy, Intrathecal methotrexate, Brain MRI