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Acute lymphoblastic leukaemia and neurological complications in children and adolescents

Abstract:

Childhood leukemia is one of the most critical diseases in children, being acute lymphoblastic leukemia (ALL) a malignant and proliferating transformation of the lymphoid progenitor cells in the bone marrow, peripheral blood, and ex-tramedullary sites. It is a heterogeneous disease whose incidence predominates in the range of 2 to 5 years of age and is more common in males. This condition implies a series of complications linked to its pathophysiology and the treatments applied. Although its occurrence is mainly in infants, it represents a catastrophic situation in adults. Genomic investigations have found polymorphic variants in different genes linked to this pathology, as well as some genetic syndromes such as Down syndrome, Fanconi anemia, among others. Its clinical manifestations may be nonspecific, with constitutional symptoms and bone marrow failure, and may involve the Central Nervous System (CNS). Its diagnosis is based on the presence of 20% or more lymphoblasts in the bone marrow or peripheral blood; on the other hand, lumbar puncture with cerebrospinal fluid analysis is the standard of care when assessing if the CNS is compromised. There are several complications related to this condition, mainly cerebrovascular events, infectious events, associated disorders due to drug toxicity, and other conditions such as reversible posterior encephalopathy syndrome, secondary brain tumors, and CNS infiltration.