Neurological Complications in Children with Acute Lymphoblastic Leukemia

Objective: To describe the frequency, clinical profile and outcome of neurological complications in children with Acute Lymphoblastic Leukemia (ALL) Methods: This retrospective observational study was conducted at Agha Khan University Hospital, Karachi, Pakistan. Study included clinical record of diagnosed acute lymphoblastic leukemia children (1 year to 18 years), admitted at pediatric oncology department between October 2009 and November 2019 to identify neurological complications during chemotherapy. SPSS version 24 was used for the purpose of statistical analysis. Mean ±SD was computed for quantitative variables like age and weight of the patients. Inferential statistics were explored using chi-square test and independent t-test. p-value <0.05 was considered significant. Results: Out of 387 children with ALL, neurological events were reported in 72 (18.60%). Out of the affected patients, majority were males (n=49, 68.05%) with 44 (61%) children in between 1-10 years of age. Among these, 43 (60%) had Precursor B cell and 18 (25%) had T-cell ALL. The number of patients who developed neurological complications during induction were 29 (40%), during consolidation phase were 16 (22%) and 6 (8%) during maintenance phase of chemotherapy. Altered level of consciousness was found in 13 (18%), convulsions in 31 (43%), and motor weakness in 14 (19%). Systemic chemotherapy with high dose methotrexate 43 (60%), and L-Asparaginase 22 (31%) along with intrathecal methotrexate 41 (57%) was the most common predisposing factor. Neuropathy was found in 1 patient only. Most of the patients had gross and full recovery by hospital discharge, 7 (10%) expired and 8 (11%) had neurological deficit on hospital discharge. Conclusions: Although most patients had full recovery, neurological complications are frequent during ALL therapy, and require early detection and prompt treatment to prevent permanent sequelae.