mercaptopurine and Peripheral-Nervous-System-Diseases

Central nervous system (CNS) complications during treatment of childhood acute lymphoblastic leukemia (ALL) remain a challenging clinical problem. Outcome improvement with more intensive chemotherapy has significantly increased the incidence and severity of adverse events. This study analyzed the incidence of neurological complications during ALL treatment in a single pediatric institution, focusing on clinical, radiological, and electrophysiological findings. Exclusion criteria included CNS leukemic infiltration at diagnosis, therapy-related peripheral neuropathy, late-onset encephalopathy, or long-term neurocognitive defects. During a 9-year period, we retrospectively collected 27 neurological events (11%) in as many patients, from 253 children enrolled in the ALL front-line protocol. CNS complications included posterior reversible leukoencephalopathy syndrome (n = 10), stroke (n = 5), temporal lobe epilepsy (n = 2), high-dose methotrexate toxicity (n = 2), syndrome of inappropriate antidiuretic hormone secretion (n = 1), and other unclassified events (n = 7). In conclusion, CNS complications are frequent events during ALL therapy, and require rapid detection and prompt treatment to limit permanent damage.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Central Nervous System; Central Nervous System Diseases; Child; Child, Preschool; Cyclophosphamide; Cytarabine; Daunorubicin; Electroencephalography; Female; Humans; Infant; Leukemic Infiltration; Magnetic Resonance Imaging; Male; Mercaptopurine; Methotrexate; Peripheral Nervous System Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Retrospective Studies; Tomography, X-Ray Computed; Vincristine

Topics: Antibodies, Monoclonal; Crohn Disease; Exanthema; Female; Gastrointestinal Agents; Humans; Infliximab; Mercaptopurine; Methotrexate; Middle Aged; Peripheral Nervous System Diseases; Steroids; Treatment Outcome; Tumor Necrosis Factor-alpha

We report a 13-year-old male patient with Charcot-Marie-Tooth disease (CMT) type 2 who developed severe neuropathy because of vincristine (VCR) for his acute lymphoblastic leukemia. A clumsy gait, muscle weakness in his fingers, and inverted champagne bottlelike muscle in the lower limbs were noticed after remission induction treatment for acute lymphoblastic leukemia, which included VCR at a total dose of 8 mg/m. An electrophysiologic study showed an almost normal median motor nerve conduction velocity (approximately 50 m/s), markedly reduced M-wave amplitude and sensory disturbance. He was diagnosed as CMT type 2 based on his symptoms and electrophysiologic findings. His symptoms gradually worsened, and even after VCR was discontinued, he could not walk alone for 7 months. VCR has previously been considered to be relatively safe in CMT type 2, however, some patients with CMT type 2 might show severe neurologic toxicities, as seen in patients with CMT type 1.

Topics: Adolescent; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Charcot-Marie-Tooth Disease; Contraindications; Cytarabine; Daunorubicin; Etoposide; Gait Disorders, Neurologic; Humans; Male; Mercaptopurine; Methotrexate; Muscle Weakness; Neural Conduction; Peripheral Nervous System Diseases; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Remission Induction; Vincristine

Protein C, protein S, and antithrombin III were measured in 35 patients with acute leukemia (13 with AML and 22 with ALL). Low levels of proteins C and S were present in 15 (42.9%) and 20 (57.1%) patients, respectively, and 6 patients had low levels of antithrombin (ATIII). Seven patients also had DIC at presentation. There were no significant differences in the levels of protein C, protein S, and ATIII in patients with or without DIC. Twenty patients were available for re-evaluation at the end of induction therapy. The low levels of protein C and ATIII found at diagnosis had risen to normal levels at the end of the induction therapy, while low =levels of protein S remained in 75% of the patients. One patient with low protein C at presentation developed myocardial infarction on day 15, and another patient died of progressive neuropathy. No other thrombotic manifestations were seen. Whether the low protein C, protein S, or antithrombin levels predispose patients with acute leukemia to thrombosis in the absence of DIC is not known.

Topics: Antineoplastic Combined Chemotherapy Protocols; Antithrombin III; Asparaginase; Cyclophosphamide; Cytarabine; Disseminated Intravascular Coagulation; Female; Humans; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Methotrexate; Myocardial Infarction; Peripheral Nervous System Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Predictive Value of Tests; Prednisone; Protein C; Protein S; Thrombosis; Vincristine

Topics: Acetazolamide; Adolescent; Amphotericin B; Candidiasis; Humans; Infectious Mononucleosis; Kidney Diseases; Leukemia; Male; Mercaptopurine; Methotrexate; Nystatin; Penicillins; Peripheral Nervous System Diseases; Prednisone; Rolitetracycline; Sepsis; Uric Acid