Journal of the Korean Pediatric Society 2003;46(6):566-571.
Published online June 15, 2003.
Leukoencephalopathy after CNS Prophylactic Therapy in Pediatric Hematologic Malignancy
Jun Hwa Lee1, Sun Min Lee2, Eun Jin Choi1, Kun Soo 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
소아 혈액종양 환자에서 중추신경계 예방적 치료 후 발생한 백질뇌병증
이준화1, 이선민2, 최은진1, 이건수2
1대구가톨릭대학교 의과대학 소아과학교실
2경북대학교 의과대학 소아과학교실
Correspondence: 
Kun Soo 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.
Key Words: Leukoencephalopathy, CNS prophylactic therapy, Intrathecal methotrexate, Brain MRI


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