Posterior Reversible Encephalopathy Syndrome in Children with Malignancies or After Hematopoietic Cell Transplantation: A Polish Nationwide Study

<b>Background/Objectives</b>: The objective of this study was to analyze the clinical and laboratory features, management, outcomes, and complications of PRES in children with malignancies or following hematopoietic cell transplantation (HCT). <b>Methods</b>: This was a multicenter retrospective analysis of PRES episodes diagnosed between 2014 and 2022 in Polish pediatric hematology and oncology (PHO) centers and HCT units. The study included 438 patients treated for malignancy or post-HCT: 120 with PRES (study group) and 318 without PRES (control group). <b>Results</b>: PRES was diagnosed in children aged 1.7-16.5 years (median = 7.7 years). The most common underlying diagnosis was ALL (76.7%; n = 92). Symptoms of PRES included disturbances of consciousness (84.2%), seizures (80.0%), hypertension (74.2%), apathy (64.2%), abdominal pain (45.0%), visual disturbances (28.3%), and headaches (26.7%). Electrolyte abnormalities were observed in 75.0% of children, most commonly hyponatremia (49.2%) and hypokalemia (37.5%). Children with PRES were more likely to require admission to the intensive care unit (ICU) than controls (50.0% vs. 29.6%, <i>p</i> < 0.001). The most frequent long-term complications of PRES were hypertension (22.5%) and epilepsy (20.8%). Among PHO patients, those with PRES had significantly lower DFS (76.7% vs. 93.7%, <i>p</i> < 0.001) and OS (79.2% vs. 93.4%, <i>p</i> < 0.001). In the HCT group, PRES was also associated with lower DFS (40.0% vs. 83.3%, <i>p</i> = 0.012) and OS (40.0% vs. 77.8%, <i>p</i> = 0.047). <b>Conclusions</b>: PRES is a significant complication of oncological and transplant treatment in children. Its occurrence was associated with worse overall and disease-free survival. We proposed a predictive index for PRES, diagnostic criteria, and a revised name for this syndrome.

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Journal
Cancers
Published
2025-11-26
DOI
https://doi.org/10.3390/cancers17233789
Citations
1
Primary Topic
Neurological Complications and Syndromes
Type
article
Field-Weighted Citation Impact
1.47
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article

Posterior Reversible Encephalopathy Syndrome in Children with Malignancies or After Hematopoietic Cell Transplantation: A Polish Nationwide Study

Tomasz Brzeski, Sonia Pająk, Wojciech Michal Mlynarski, Krzysztof Kałwak et al.
1 citations
Cancers
Neurological Complications and Syndromes
1.47
article

Posterior Reversible Encephalopathy Syndrome in Children with Malignancies or After Hematopoietic Cell Transplantation: A Polish Nationwide Study

Tomasz Brzeski, Sonia Pająk, Wojciech Michal Mlynarski, Krzysztof Kałwak, Radosław Chaber, Agnieszka Mizia‐Malarz, M. Bartnik, Katarzyna Koch, Bożenna Dembowska–Bagińska, Katarzyna Drabko, Pawel Jozef Laguna, Karolina Gawle‐Krawczyk, Szymon Skoczeń, Julia Kołodrubiec, Grażyna Karolczyk, Grzegorz Waliszczak, Marta Malczewska, Agnieszka Chodała-Grzywacz, Walentyna Balwierz, Anna Małecka, K Czyźewski, Iwona Rurańska, Patrycja Marciniak-Stępak, Maryna Krawczuk‐Rybak, Jacek Wachowiak, Martyna Korzeniewicz, Małgorzata Sawicka-Żukowska, Katarzyna Derwich, Ninela Irga‐Jaworska, Tomasz Szczepański, Magdalena Tarasińska, Katarzyna Mycko, Wanda Badowska, Wioletta Bal, Aleksandra Kiermasz, Tomasz Jarmoliński, Jan Styczyński, Monika Richert-Przygońska, Tomasz Urasiński, Tomasz Ociepa, Patrycja Tyszka
article en
1 citations

Abstract

<b>Background/Objectives</b>: The objective of this study was to analyze the clinical and laboratory features, management, outcomes, and complications of PRES in children with malignancies or following hematopoietic cell transplantation (HCT). <b>Methods</b>: This was a multicenter retrospective analysis of PRES episodes diagnosed between 2014 and 2022 in Polish pediatric hematology and oncology (PHO) centers and HCT units. The study included 438 patients treated for malignancy or post-HCT: 120 with PRES (study group) and 318 without PRES (control group). <b>Results</b>: PRES was diagnosed in children aged 1.7-16.5 years (median = 7.7 years). The most common underlying diagnosis was ALL (76.7%; n = 92). Symptoms of PRES included disturbances of consciousness (84.2%), seizures (80.0%), hypertension (74.2%), apathy (64.2%), abdominal pain (45.0%), visual disturbances (28.3%), and headaches (26.7%). Electrolyte abnormalities were observed in 75.0% of children, most commonly hyponatremia (49.2%) and hypokalemia (37.5%). Children with PRES were more likely to require admission to the intensive care unit (ICU) than controls (50.0% vs. 29.6%, <i>p</i> < 0.001). The most frequent long-term complications of PRES were hypertension (22.5%) and epilepsy (20.8%). Among PHO patients, those with PRES had significantly lower DFS (76.7% vs. 93.7%, <i>p</i> < 0.001) and OS (79.2% vs. 93.4%, <i>p</i> < 0.001). In the HCT group, PRES was also associated with lower DFS (40.0% vs. 83.3%, <i>p</i> = 0.012) and OS (40.0% vs. 77.8%, <i>p</i> = 0.047). <b>Conclusions</b>: PRES is a significant complication of oncological and transplant treatment in children. Its occurrence was associated with worse overall and disease-free survival. We proposed a predictive index for PRES, diagnostic criteria, and a revised name for this syndrome.

CancersVol. 17(23)
Poznan University of Medical Sciences (PL), Medical University of Lublin (PL), Jagiellonian University (PL), Medical University of Białystok (PL), Medical University of Silesia (PL), Kielce University of Technology (PL), Medical University of Warsaw (PL), Nicolaus Copernicus University (PL), Wroclaw Medical University (PL), Uniwersytecki Szpital Dziecięcy (PL), Children's Memorial Health Institute (PL), Medical University of Lodz (PL), Collegium Medicum in Bydgoszcz (PL), University of Warmia and Mazury in Olsztyn (PL), Gdańsk Medical University (PL), Pomeranian Medical University (PL), University of Rzeszów (PL)
Openalex Percentile: Top 13%
Neurological Complications and Syndromes
1.47
DOIOpen Access PDFOpenAlex
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