Abstract
The pattern of acute and long-term neurological complications in 133 children with acute lymphoblastic leukemia (ALL) treated with two treatment protocol was reviewed. Twenty patients developed neurological complications. Nine out of 20 patients received MRC UK ALL X and the remaining 11 received MRC UK ALL XI protocol. There was no difference of neurological complications between MRC UKALL X and UK ALL XI protocol groups. The numbers of patients who developed neurological complications during induction of remission period were 11 of 133 patients (8.2%). 122 patients were observed during the maintenance period of treatment (from 6 months to 36 months). Six out of 122 patients developed neurological complications during this period. 88 patients were followed for a period of up to 6 months after the cessation of chemotherapy, i.e., in the late period. Neurological complications were found in 3 during this period. Neurological complications rate was 4 times higher in the relapsed group than in the no relapsed group (p < 0.05). Systemic chemotherapy (including vincristine, high-dose methotrexate) and intrathecal chemotherapy seem to be the most common predisposing factors.
Highlights
The progress made in treatment of acute lymphoblastic leukemia (ALL) of childhood is one of the successes of modern medicine
This therapeutic progress is the result of treatment advances that began with the identification of effective single agent chemotherapy in the late 1940s, followed by development of combination chemotherapy and maintenance chemotherapy in the 1950s and early 1960s and the implementation of effective central nervous system (CNS) preventive therapy in the 1960s and 1970s
The incidence of neurological complications in children with ALL varies between 3% and 13% depending on the various studies[6]
Summary
The progress made in treatment of acute lymphoblastic leukemia (ALL) of childhood is one of the successes of modern medicine. Incremental advances in treatment success span a 50-year period, during which ALL has gone from a uniformly fatal disease to one with an overall cure rate greater than 75%1-3. This therapeutic progress is the result of treatment advances that began with the identification of effective single agent chemotherapy in the late 1940s, followed by development of combination chemotherapy and maintenance chemotherapy in the 1950s and early 1960s and the implementation of effective central nervous system (CNS) preventive therapy in the 1960s and 1970s. Common neurological complications developing after completion of ALL treatment include leukoencephalopathy and neurocognitive defects[6,7,8]
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