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Severe steroid-related neuropsychiatric symptoms during paediatric acute lymphoblastic leukaemia therapy—An observational Ponte di Legno Toxicity Working Group Study

Lookup NU author(s): Dr Lina Hamadeh

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 2024 The Author(s). British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.Steroids are a mainstay in the treatment of acute lymphoblastic leukaemia (ALL) in children and adolescents; however, their use can cause clinically significant steroid-related neuropsychiatric symptoms (SRNS). As current knowledge on SRNS during ALL treatment is limited, we mapped the phenotypes, occurrence and treatment strategies using a database created by the international Ponte di Legno Neurotoxicity Working Group including data on toxicity in the central nervous system (CNS) in patients treated with frontline ALL protocols between 2000 and 2017. Ninety-four of 1813 patients in the CNS toxicity database (5.2%) experienced clinically significant SRNS with two peaks: one during induction and one during intensification phase. Dexamethasone was implicated in 86% of SRNS episodes. The most common symptoms were psychosis (52%), agitation (44%) and aggression (31%). Pharmacological treatment, mainly antipsychotics and benzodiazepines, was given to 87% of patients while 38% were hospitalised due to their symptoms. Recurrence of symptoms was reported in 29% of patients and two previously healthy patients required ongoing pharmacological treatment at the last follow up. Awareness of SRNS during ALL treatment and recommendation on treatment strategies merit further studies and consensus.

Publication metadata

Author(s): Anastasopoulou S, Swann G, Andres-Jensen L, Attarbaschi A, Barzilai-Birenboim S, Erdelyi DJ, Escherich G, Hamadeh L, Harila A, Lopez-Lopez E, McGowan S, Moricke A, Putti C, Sagi JC, Schmiegelow K, Ullrich NJ, van der Sluis IM, Wahid Q-U-A, Winick N, Sramkova L, Zalcberg Y, Zapotocka E, Bhojwani D, Halsey C

Publication type: Article

Publication status: Published

Journal: British Journal of Haematology

Year: 2024

Pages: epub ahead of print

Online publication date: 25/06/2024

Acceptance date: 12/06/2024

Date deposited: 08/07/2024

ISSN (print): 0007-1048

ISSN (electronic): 1365-2141

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1111/bjh.19610

DOI: 10.1111/bjh.19610

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