Reporting on Adverse Clinical Events

Abstract

A 7-year-old patient developed thunderclap headaches shortly after receiving chemotherapy for the treatment of B-cell precursor acute lymphoblastic leukemia. The patient had already completed induction therapy, early intensification, and intensification without event. The headaches occurred on days 6 and 7 of reinduction, after receiving oral dexamethasone (10 mg/m daily from day 1), vincristine (1.5 mg/m) and pirarubicin (25 mg/m) on day 1, and L-asparaginase (10 000 U/m on days 1 and 4). A cerebral magnetic resonance angiography revealed cerebral vasoconstriction. Chemotherapy was continued with adjunctive nifedipine without further recurrence until the entire chemotherapy regimen was completed. Reversible cerebral vasoconstriction syndrome was diagnosed. A repeat angiography at 5 months demonstrated normal vessels. The authors concluded that this patient developed reversible cerebral vasoconstriction syndrome in relation to chemotherapy based on the temporal relationship between the administration of the drugs and onset and resolution of symptoms. They noted that antineoplastics are not typically associated with this syndrome but that a few pediatric case reports have been previously published. Chemotherapy [“Vincristine,” “Pirarubicin,” “L-Asparaginase”] Aoki T et al (T Aoki, Department of Hematology/Oncology, Saitama Children’s Medical Center, Chiba, Japan) Reversible cerebral vasoconstriction syndrome during chemotherapy for acute lymphoblastic leukemia. J Pediatr 180:284 (Jan) 2017