Clinical Characteristics and Long-Term Follow-Up of Leukoencephalopathy in Pediatric Acute Lymphoblastic Leukemia After Chemotherapy.
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PURPOSE: This study aimed to investigate the clinical characteristics and long-term outcomes of leukoencephalopathy (LE) in pediatric patients with acute lymphoblastic leukemia (ALL) after chemotherapy, with the goal of evaluating diagnosis, treatment, and prognosis. METHODS: We retrospectively analyzed the clinical data of 48 pediatric ALL patients diagnosed with LE after chemotherapy at the Children's Hospital of Soochow University (February 2010-December 2024). Data included general information, Clinical manifestations and diagnostic imaging results. Compared with a control group of 27 healthy children, the patients' cognitive function was assessed by using the Behavioural Rating Inventory of Executive Function-2 (BRIEF-2) and the Wechsler Intelligence Scale for Children (WISC). RESULTS: Neurological symptoms were observed in 47.92% (23/48) of LE patients, including seizures (27.08%), paralysis (12.50%), limb numbness (10.42%), and speech impairment (10.42%). Brain MRI revealed white matter abnormalities, predominantly in the periventricular regions (47.92%), parietal lobes (37.50%), and frontal lobes (22.92%). Long-term follow-up demonstrated that 73.91% of symptomatic patients experienced rapid neurological improvement, and 83.33% of cases showed a significant reduction in MRI lesions within 12 months. Compared to controls, patients with LE exhibited higher BRIEF-2 scores (indicating executive dysfunction) for self-monitoring, emotional control, working memory, and planning/organization (all P < 0.05). The WISC scores were significantly lower for the total IQ, perceptual reasoning, working memory, and processing speed (P < 0.05). CONCLUSION: Post-chemotherapy LE in pediatric ALL presents with diverse neurological symptoms and neuroimaging abnormalities accompanied by mild-to-moderate cognitive deficits. However, the prognosis appears favorable, with most patients showing symptom resolution and improved imaging findings.