Incidence of Hypertension During Induction Therapy in Children with Acute Lymphoblastic Leukemia.

Abstract

Objective: To estimate the incidence of hypertension during induction therapy in children with acute lymphoblastic leukemia (ALL), comparing a systematically monitored prospective cohort to a retrospective cohort lacking regular blood pressure monitoring.

Methods: This ambispective observational study was conducted at a pediatric hematology-oncology unit in Chandigarh, India. The prospective cohort included 46 children with B-/T-ALL or T-cell non-Hodgkin lymphoma enrolled between September 2023 and August 2024, whose blood pressure was monitored weekly during induction therapy using the auscultatory method with an aneroid sphygmomanometer. Hypertension was defined according to the 2017 American Academy of Pediatrics guidelines. The retrospective cohort comprised 160 children diagnosed between June 2022 and July 2023, whose case files were reviewed for documented hypertension or posterior reversible encephalopathy syndrome (PRES). In the retrospective cohort, blood pressure was not monitored systematically and was detected incidentally during routine care or at the time of admission for intercurrent illnesses.

Results: Hypertension was observed in 27 (58.7%) patients in the prospective cohort, compared to 20 (12.5%) in the retrospective (P < 0.001). Most (92.6%) cases of hypertension in the prospective cohort occurred within the first two weeks of induction. No case vs. two (1.3%) cases of PRES were reported in the prospective and retrospective cohorts.

Conclusion: The incidence of hypertension during induction therapy in childhood ALL was 58.7%, with most cases occurring within the first two weeks. Incorporating blood pressure monitoring into routine care is essential for children with ALL receiving induction chemotherapy.