Clinical Characteristics and Long-Term Follow-Up of Leukoencephalopathy in Pediatric Acute Lymphoblastic Leukemia After Chemotherapy.

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.