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Posterior reversible encephalopathy syndrome in an adult patient with acute lymphoblastic leukemia after remission induction chemotherapy

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Abstract

Posterior reversible encephalopathy syndrome (PRES) has been reported in childhood leukemia patients increasingly frequently. However, the development of PRES in adult leukemia patients during chemotherapy is very rare. We present a case of PRES in an adult patient with acute lymphoblastic leukemia (ALL) after remission induction chemotherapy. A 28-year-old woman with ALL was administered remission induction chemotherapy consisting of cyclophosphamide, daunorubicin, vincristine, prednisone, and l-asparaginase. After initiation of chemotherapy, the patient developed paralytic ileus and hypertension, and on day 30, she suddenly developed generalized convulsions, loss of visual acuity, and muscle weakness in the legs. Magnetic resonance imaging findings and her signs and symptoms were typical of PRES. The symptoms gradually improved following treatment with an anticonvulsant and an antihypertensive agent, and the patient underwent allogeneic bone marrow transplantation. She has completely recovered from PRES and has been asymptomatic without leukemia relapse. During remission induction chemotherapy for ALL, PRES may be caused by multiple drugs, such as l-asparaginase, vincristine, and corticosteroids, with different mechanisms of action. PRES should be recognized as an important complication, which will occur more frequently with the increased intensity of chemotherapy for adult ALL patients.

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References

  1. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334:494–500.

    Article  PubMed  CAS  Google Scholar 

  2. Casey SO, Sampaio RC, Michel E, Truwit CL. Posterior reversible encephalopathy syndrome: utility of fluid-attenuated inversion recovery MR imaging in the detection of cortical and subcortical lesions. AJNR Am J Neuroradiol. 2000;21:1199–206.

    PubMed  CAS  Google Scholar 

  3. de Laat P, Te Winkel ML, Devos AS, Catsman-Berrevoets CE, Pieters R, van den Heuvel-Eibrink MM. Posterior reversible encephalopathy syndrome in childhood cancer. Ann Oncol. 2011;22:472–8.

    Article  PubMed  Google Scholar 

  4. Miyazawa Y, Irisawa H, Matsushima T, Mitsui T, Uchiumi H, Saitohi T, et al. Reversible posterior leukoencephalopathy syndrome probably caused by l-asparaginase. Rinsho Ketsueki. 2006;47:531–5.

    PubMed  Google Scholar 

  5. Reutenauer S, Albucher JF, Pariente J, Dumas H, Milioto O, Attal M, et al. Posterior reversible encephalopathy syndrome: two cases in young adults with acute lymphoblastic leukemia. Leuk Res. 2009;33:e1–3.

    Article  PubMed  CAS  Google Scholar 

  6. Feske SK. Posterior reversible encephalopathy syndrome: a review. Semin Neurol. 2011;31:202–15.

    Article  PubMed  Google Scholar 

  7. Vavilala MS, Kincaid MS, Muangman SL, Suz P, Rozet I, Lam AM. Gender differences in cerebral blood flow velocity and autoregulation between the anterior and posterior circulations in healthy children. Pediatr Res. 2005;58:574–8.

    Article  PubMed  Google Scholar 

  8. Panis B, Vlaar AM, van Well GT, Granzen B, Weber JW, Postma AA, et al. Posterior reversible encephalopathy syndrome in paediatric leukaemia. Eur J Paediatr Neurol. 2010;14:539–45.

    Article  PubMed  Google Scholar 

  9. Titos-Arcos JC, Leon-Villar J, Amigo-Lozano ML, Muina-Juarez B. Posterior reversible leukoencephalopathy syndrome induced by l-asparaginase in a teenage female diagnosed with acute lymphoblastic leukemia. Rev Neurol. 2011;52:58–60.

    PubMed  Google Scholar 

  10. Rathi B, Azad RK, Vasudha N, Hissaria P, Sawlani V, Gupta RK. l-asparaginase-induced reversible posterior leukoencephalopathy syndrome in a child with acute lymphoblastic leukemia. Pediatr Neurosurg. 2002;37:203–5.

    Article  PubMed  Google Scholar 

  11. Hourani R, Abboud M, Hourani M, Khalifeh H, Muwakkit S. l-asparaginase-induced posterior reversible encephalopathy syndrome during acute lymphoblastic leukemia treatment in children. Neuropediatrics. 2008;39:46–50.

    Article  PubMed  CAS  Google Scholar 

  12. Parasole R, Petruzziello F, Menna G, Mangione A, Cianciulli E, Buffardi S, et al. Central nervous system complications during treatment of acute lymphoblastic leukemia in a single pediatric institution. Leuk Lymphoma. 2010;51:1063–71.

    Article  PubMed  CAS  Google Scholar 

  13. Schneider P, Van Dreden P, Rousseau A, Kassim Y, Legrand E, Vannier JP, et al. Increased levels of tissue factor activity and procoagulant phospholipids during treatment of children with acute lymphoblastic leukaemia. Br J Haematol. 2010;148:582–92.

    Article  PubMed  CAS  Google Scholar 

  14. Lucchini G, Grioni D, Colombini A, Contri M, De Grandi C, Rovelli A, et al. Encephalopathy syndrome in children with hemato-oncological disorders is not always posterior and reversible. Pediatr Blood Cancer. 2008;51:629–33.

    Article  PubMed  Google Scholar 

  15. Norman JK, Parke JT, Wilson DA, McNall-Knapp RY. Reversible posterior leukoencephalopathy syndrome in children undergoing induction therapy for acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49:198–203.

    Article  PubMed  Google Scholar 

  16. Gupta A, Swaroop C, Rastogi R, Garg R, Bakhshi S. Simultaneous occurrence of posterior reversible leukoencephalopathy syndrome in two cases of childhood acute lymphoblastic leukemia induction chemotherapy. Pediatr Hematol Oncol. 2008;25:351–8.

    Article  PubMed  Google Scholar 

  17. Pui CH, Evans WE. Treatment of acute lymphoblastic leukemia. N Engl J Med. 2006;354:166–78.

    Article  PubMed  CAS  Google Scholar 

  18. Hoshino K, Asou N, Suzushima H, Osato M, Yamasaki H, Okubo T, et al. TEL/AML1 fusion gene resulting from a cryptic t(12;21) is uncommon in adult patients with B-cell lineage ALL and CML lymphoblastic transformation. Int J Hematol. 1997;66:213–8.

    Article  PubMed  CAS  Google Scholar 

  19. Boissel N, Auclerc MF, Lheritier V, Perel Y, Thomas X, Leblanc T, et al. Should adolescents with acute lymphoblastic leukemia be treated as old children or young adults? Comparison of the French FRALLE-93 and LALA-94 trials. J Clin Oncol. 2003;21:774–80.

    Article  PubMed  Google Scholar 

  20. de Bont JM, Holt B, Dekker AW, den Berg A, Sonneveld P, Pieters R. Significant difference in outcome for adolescents with acute lymphoblastic leukemia treated on pediatric vs adult protocols in the Netherlands. Leukemia. 2004;18:2032–5.

    Article  PubMed  Google Scholar 

  21. Ramanujachar R, Richards S, Hann I, Goldstone A, Mitchell C, Vora A, et al. Adolescents with acute lymphoblastic leukaemia: outcome on UK national paediatric (ALL97) and adult (UKALLXII/E2993) trials. Pediatr Blood Cancer. 2007;48:254–61.

    Article  PubMed  Google Scholar 

  22. Usvasalo A, Raty R, Knuutila S, Vettenranta K, Harila-Saari A, Jantunen E, et al. Acute lymphoblastic leukemia in adolescents and young adults in Finland. Haematologica. 2008;93:1161–8.

    Article  PubMed  CAS  Google Scholar 

  23. Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, et al. Pediatric-inspired therapy in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia: the GRAALL-2003 study. J Clin Oncol. 2009;27:911–8.

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Shokichi Tsukamoto, Masahiro Takeuchi, Chika Kawajiri, Satomi Tanaka, Yuhei Nagao, Yasumasa Sugita, Atsuko Yamazaki, Takeharu Kawaguchi, Tomoya Muto, Shio Sakai, Yusuke Takeda, Chikako Ohwada, Emiko Sakaida, Naomi Shimizu, Tohru Iseki & Chiaki Nakaseko

  2. Department of Blood Transfusion, Chiba University Hospital, Chiba, Japan

    Tomoya Muto, Shio Sakai, Naomi Shimizu & Tohru Iseki

  3. Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan

    Koutaro Yokote

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  1. Shokichi Tsukamoto
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  2. Masahiro Takeuchi
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Corresponding author

Correspondence to Chiaki Nakaseko.

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Tsukamoto, S., Takeuchi, M., Kawajiri, C. et al. Posterior reversible encephalopathy syndrome in an adult patient with acute lymphoblastic leukemia after remission induction chemotherapy. Int J Hematol 95, 204–208 (2012). https://doi.org/10.1007/s12185-011-0982-9

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  • DOI: https://doi.org/10.1007/s12185-011-0982-9

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