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

• Published in: International journal of hematology Vol. 95; no. 2; pp. 204 - 208
• Main Authors: Tsukamoto, Shokichi, Takeuchi, Masahiro, Kawajiri, Chika, Tanaka, Satomi, Nagao, Yuhei, Sugita, Yasumasa, Yamazaki, Atsuko, Kawaguchi, Takeharu, Muto, Tomoya, Sakai, Shio, Takeda, Yusuke, Ohwada, Chikako, Sakaida, Emiko, Shimizu, Naomi, Yokote, Koutaro, Iseki, Tohru, Nakaseko, Chiaki
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01-02-2012; Springer; Springer Nature B.V
• Subjects: Acuity; Acute lymphatic leukemia; Adult; Anticonvulsants; Antihypertensives; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Asparaginase - adverse effects; Biological and medical sciences; Bone marrow transplantation; Case Report; Chemotherapy; Children; Convulsions; Corticoids; Cyclophosphamide; Cyclophosphamide - adverse effects; Daunorubicin; Daunorubicin - adverse effects; Drug toxicity and drugs side effects treatment; Encephalopathy; Female; Hematologic and hematopoietic diseases; Hematology; Humans; Hypertension; Immunosuppressive agents; L-asparaginase; Leg; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Magnetic resonance imaging; Medical sciences; Medicine; Medicine & Public Health; Muscles; Oncology; Pharmacology. Drug treatments; Posterior Leukoencephalopathy Syndrome - chemically induced; Posterior Leukoencephalopathy Syndrome - diagnostic imaging; Posterior Leukoencephalopathy Syndrome - pathology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Prednisone; Prednisone - adverse effects; Radiography; Remission; Remission Induction; Toxicity: nervous system and muscle; Vincristine; Vincristine - adverse effects; Adult; asparaginase; Vincristine; Posterior reversible encephalopathy syndrome (PRES); Acute lymphoblastic leukemia (ALL); Antineoplastic agent; Toxicity; Alkaloid; Daunorubicin; Posterior reversible encephalopathy syndrome; Lymphoproliferative syndrome; Complication; Female; Remission; Acute lymphocytic leukemia; Antimitotic; Human; Nervous system diseases; Drug combination; Hematology; Enzyme; L-asparaginase; Malignant hemopathy; Induction treatment; Cerebral disorder; Case study; Alkylating agent; Oxazaphosphinane derivatives; Chemotherapy; Cyclophosphamide; Treatment; Nitrogen mustard; Central nervous system disease; Young adult; Hydrolases; Anthracyclins; Asparaginase; Cancer
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-011-0982-9

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
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-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
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-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.