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Child's Nervous System

, Volume 25, Issue 5, pp 619–626 | Cite as

Poor-risk high-grade gliomas in three survivors of childhood acute lymphoblastic leukaemia—an overview of causative factors and possible therapeutic options

  • Ewa Bien
  • Teresa Stachowicz-Stencel
  • Magdalena Szalewska
  • Malgorzata Krawczyk
  • Anna Synakiewicz
  • Miroslawa Dubaniewicz-Wybieralska
  • Piotr Zielinski
  • Elzbieta Adamkiewicz-Drozynska
  • Anna Balcerska
Case Report

Abstract

Purpose

Malignant high-grade gliomas are the most common secondary neoplasms in children cured of acute lymphoblastic leukaemia (ALL). Although many predisposing factors exist (including systemic or intrathecal chemotherapy, young age, brain infiltration and genetic predispositions), cranial irradiation appears to be the strongest one.

Methods

Three cases of secondary high-grade gliomas (two multiform glioblastomas, grade IV; one anaplastic astrocytoma, grade III) developed in ALL survivors (F–M, 1:2) 3 to 6.3 years after stopping ALL therapy according to BFM-90 trial.

Results

All tumours were supratentorial, contrast-enhancing, space-occupying, highly advanced and aggressive. Possible risk factors and current therapeutic options for paediatric ALL and malignant gliomas are reviewed and discussed.

Conclusions

Prognosis in secondary malignant gliomas in children is poor (overall survival of 5, 10 and 19 months) despite intense therapy. Thus, protocols for paediatric ALL reduce prophylactic cranial irradiation in favour of intrathecal and intravenous high-dose MTX. Nevertheless, ALL survivors must undergo systematic, long-term surveillance for early detection of intracranial neoplasms.

Keywords

Acute lymphoblastic leukaemia Secondary neoplasia High-grade glioma Cranial radiotherapy complications Intrathecal methotrexate Children 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ewa Bien
    • 1
  • Teresa Stachowicz-Stencel
    • 1
  • Magdalena Szalewska
    • 1
  • Malgorzata Krawczyk
    • 1
  • Anna Synakiewicz
    • 1
  • Miroslawa Dubaniewicz-Wybieralska
    • 2
  • Piotr Zielinski
    • 3
  • Elzbieta Adamkiewicz-Drozynska
    • 1
  • Anna Balcerska
    • 1
  1. 1.Department of Paediatrics, Haematology, Oncology and EndocrinologyMedical University of GdanskGdanskPoland
  2. 2.Department of RadiologyMedical University of GdanskGdanskPoland
  3. 3.Department of NeurosurgeryMedical University of GdanskGdanskPoland

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