Vol. 2 No. 1 (2019)
Review Article

Neurological Complications of Childhood Hematological Disorders and Solid Malignancies: A Brief Review

Panda PK
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

Published 2019-01-22

Abstract

Hematological disorders are often associated with various neurological complications during the course of the disease and often as adverse effect due to the treatment instituted. Iron deficiency anemia has definite role in the pathogenesis of breath holding spell and ischemic stroke in children. Sickle cell anemia is also associated with increased risk of arterial ischemic stroke and Moyamoya disease. Acute lymphoblastic and myelogenous leukemia are also associated with various neurological complications due to CNS spread, complications of chemotherapy, tumor lysis syndrome, hyperleukocytosis and opportunistic infections. Rarely, paraneoplastic complications like Ophelia syndrome and Opsoclonus Myoclonus Ataxia syndrome can be seen in children with Hodgkin lymphoma and Neuroblastoma respectively. This review article briefly describes individually various neurological complications associated with hematological disorders and malignancies in children, and their current evidence based management guidelines.

References

  1. Andersen MH. The targeting of immunosuppressive mechanisms in hematological malignancies. Leukemia. 2014;28(9):1784-1792. doi: https://doi.org/10.1038/leu.2014.108
  2. Bhatt VR, Viola GM, Ferrajoli A. Invasive fungal infections in acute leukemia. Ther Adv Hematol. 2011;2(4):231-247. doi: https://doi.org/10.1177/2040620711410098
  3. Hamed SA, Gad EF, Sherif TK. Iron deficiency and cyanotic breath-holding spells: The effectiveness of iron therapy. Pediatr Hematol Oncol. October 2018:1-10. doi: https://doi.org/10.1080/08880018.2018.1491659
  4. Kaiafa G, Savopoulos C, Kanellos I, et al. Anemia and stroke: Where do we stand? Acta Neurol Scand. 2017;135(6):596-602. doi: https://doi.org/10.1111/ane.12657
  5. Marks LJ, Munube D, Kasirye P, et al. Stroke prevalence in children with sickle cell disease in sub-saharan africa: A systematic review and meta-analysis. Glob Pediatr Health. 2018;5:2333794X1877497. doi: https://doi.org/10.1177/2333794X18774970
  6. Talahma M, Strbian D, Sundararajan S. Sickle cell disease and stroke. Stroke. 2014;45(6):e98-100. https://www.ahajournals.org/doi/abs/10.1161/strokeaha.114.005144
  7. Mihalov J, Timárová G. A seeming paradox: Ischemic stroke in the context of idiopathic thrombocytopenic purpura. Clin Appl Thromb Hemost. 2016;22(2):115-120. doi: https://doi.org/10.1177/1076029614545213
  8. Rojas Hernandez C, Oo T. Advances in mechanisms, diagnosis, and treatment of pernicious anemia. Discov Med. 2015;19(104):159-168. https://www.ncbi.nlm.nih.gov/pubmed/25828519
  9. Glaser K, Girschick HJ, Schropp C, Speer CP. Psychomotor development following early treatment of severe infantile vitamin B12 deficiency and west syndrome – Is everything fine? A case report and review of literature. Brain Dev. 2015;37(3):347-351. doi: https://doi.org/10.1016/j.braindev.2014.05.006
  10. Berg SL, Chamberlain MC. Systemic chemotherapy, intrathecal chemotherapy, and symptom management in the treatment of leptomeningeal metastasis. Curr Oncol Rep. 2003;5(1):29-40. doi: https://doi.org/10.1007/s11912-003-0084-9
  11. Soffietti R, Trevisan E, Rudà R. Neurologic complications of chemotherapy and other newer and experimental approaches. Handb Clin Neurol. 2014;121:1199-1218. https://www.ncbi.nlm.nih.gov/pubmed/24365412
  12. Jongen JLM, Broijl A, Sonneveld P. Chemotherapy-induced peripheral neuropathies in hematological malignancies. J Neurooncol. 2015;121(2):229-237. doi: https://doi.org/10.1007/s11060-014-1632-x
  13. Wang B, Yang L, Yu L, Chen X, Hu Y. Clinical analysis of adverse drug reactions between vincristine and triazoles in children with acute lymphoblastic leukemia. Med Sci Monit. 2015;21:1656-1661. doi: https://doi.org/10.12659/MSM.893142
  14. Inaba H, Pei D, Wolf J, et al. Infection-related complications during treatment for childhood acute lymphoblastic leukemia. Ann Oncol. 2017;28(2):386-392. doi: https://doi.org/10.1093/annonc/mdw557
  15. Caniza MA, Odio C, Mukkada S, et al. Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries. Expert Rev Hematol. 2015;8(5):627-645. doi: https://doi.org/10.1586/17474086.2015.1071186
  16. Juneja M, Kaur S, Mishra D, Jain S. Ophelia syndrome: Hodgkin lymphoma with limbic encephalitis. Indian Pediatr. 2015;52(4):335-336. https://www.ncbi.nlm.nih.gov/pubmed/25929634
  17. Tang J-H, Tian J-M, Sheng M, et al. Study of posterior reversible encephalopathy syndrome in children with acute lymphoblastic leukemia after induction chemotherapy. J Child Neurol. 2016;31(3):279-284. doi: https://doi.org/10.1177/0883073815589758
  18. Blaes F, Dharmalingam B. Childhood opsoclonus-myoclonus syndrome: diagnosis and treatment. Expert Rev Neurother. 2016;16(6):641-648. doi: https://doi.org/10.1080/14737175.2016.1176914
  19. Trahair T, Sorrentino S, Russell SJ, et al. Spinal canal involvement in neuroblastoma. J Pediatr. 2017;188:294-298. doi: https://doi.org/10.1016/j.jpeds.2017.05.051
  20. Gündüz K, Müftüoglu O, Günalp I, Unal E, Taçyildiz N. Metastatic retinoblastoma clinical features, treatment, and prognosis. Ophthalmology. 2006;113(9):1558-6. https://www.aaojournal.org/article/S0161-6420(06)00452-0/abstract
  21. Kose D, Paksoy Y, Koksal Y, Unal E. Neurological complication of non hodgkin lymphoma in childhood: experience from a single center in turkey. Childs Nerv Syst. 2014;30(4):639-645. doi: https://doi.org/10.1007/s00381-013-2267-5
  22. Firwana BM, Hasan R, Hasan N, et al. Tumor lysis syndrome: A systematic review of case series and case reports. Postgrad Med. 2012;124(2):92-101. doi: https://doi.org/10.3810/pgm.2012.03.2540
  23. Abla O, Angelini P, Di Giuseppe G, et al. Early complications of hyperleukocytosis and leukapheresis in childhood acute leukemias. J Pediatr Hematol Oncol. 2016;38(2):111-117. doi: https://doi.org/10.1097/MPH.0000000000000490
  24. Cruz ML, Farooq S, Testai FD. Neurological and neurosurgical emergencies in patients with hematological disorders. Curr Neurol Neurosci Rep. 2017;17(3):24. doi: https://doi.org/10.1007/s11910-017-0728-z