Elevated intraocular pressure in children with acute lymphoblastic leukaemia: A prospective study

Shlomit Barzilai-Birenboim; Sarah Elitzur; Ronit Nirel; Miriam Ehrenberg; Alon Zahavi; Galia Avrahami; Itay E. Gabbay; Gil Gilad; Gad Dotan; Shai Izraeli; Rabeea Haj Daood; Noa Geffen

doi:10.1111/bjh.17987

Elevated intraocular pressure in children with acute lymphoblastic leukaemia: A prospective study

Shlomit Barzilai-Birenboim^*, Sarah Elitzur, Ronit Nirel, Miriam Ehrenberg, Alon Zahavi, Galia Avrahami, Itay E. Gabbay, Gil Gilad, Gad Dotan, Shai Izraeli, Rabeea Haj Daood, Noa Geffen

^*Corresponding author for this work

Department of Statistics

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Abstract

Most childhood acute lymphoblastic leukaemia (ALL) protocols include high-dose steroid therapy. However, the known potential of high-dose steroids to significantly elevate intraocular pressure (IOP) and lead to glaucomatous optic neuropathy has not been intensively investigated in children with ALL. Moreover, as children with ALL do not routinely undergo IOP measurements, the need for IOP monitoring and therapy is unknown. We prospectively measured IOP in 90 children with newly diagnosed ALL attending a tertiary paediatric haematology/oncology centre, at diagnosis and at the middle and end of induction therapy. Ocular hypertension (IOP > 21 mm Hg) at any time point was documented in 64 children (71%), and the prevalence increased during induction. Thirty-six children (40%) had elevated IOP at ALL diagnosis before therapy initiation, and stratification to non-standard ALL was a risk factor. IOP reduction therapy was administered to 13 children (14%); none required surgery. Values normalised in all cases. On multivariate logistic regression analysis, dexamethasone therapy was a significant risk factor for ocular hypertension. High body mass index was an additional risk factor in children with elevated IOP at ALL diagnosis. Routine evaluation of IOP during steroid therapy is very important in children with ALL to ensure early intervention which may prevent permanent ocular damage.

Original language	American English
Pages (from-to)	1248-1256
Number of pages	9
Journal	British Journal of Haematology
Volume	196
Issue number	5
DOIs	https://doi.org/10.1111/bjh.17987
State	Published - Mar 2022

Bibliographical note

Funding Information:
This work was supported by the Israeli Society of Paediatric Haemato-Oncology, the Israel Cancer Association, and Amutat Haim. Special thanks to Dina Kugel and Naomi Litichever, the data coordinators of the Israel National Study of Childhood ALL for their invaluable work, to Gioia Blayer of the Hebrew University for her help with the statistical analyses, and the English Language Service of Rabin Medical Center for editing of the manuscript.

Funding Information:
This work was supported by the Israeli Society of Paediatric Haemato‐Oncology, the Israel Cancer Association, and Amutat Haim. Special thanks to Dina Kugel and Naomi Litichever, the data coordinators of the Israel National Study of Childhood ALL for their invaluable work, to Gioia Blayer of the Hebrew University for her help with the statistical analyses, and the English Language Service of Rabin Medical Center for editing of the manuscript.

Publisher Copyright:
© 2021 British Society for Haematology and John Wiley & Sons Ltd

Keywords

acute lymphoblastic leukaemia
elevated intraocular pressure
high-dose steroids
risk factors

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10.1111/bjh.17987

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title = "Elevated intraocular pressure in children with acute lymphoblastic leukaemia: A prospective study",

abstract = "Most childhood acute lymphoblastic leukaemia (ALL) protocols include high-dose steroid therapy. However, the known potential of high-dose steroids to significantly elevate intraocular pressure (IOP) and lead to glaucomatous optic neuropathy has not been intensively investigated in children with ALL. Moreover, as children with ALL do not routinely undergo IOP measurements, the need for IOP monitoring and therapy is unknown. We prospectively measured IOP in 90 children with newly diagnosed ALL attending a tertiary paediatric haematology/oncology centre, at diagnosis and at the middle and end of induction therapy. Ocular hypertension (IOP > 21 mm Hg) at any time point was documented in 64 children (71%), and the prevalence increased during induction. Thirty-six children (40%) had elevated IOP at ALL diagnosis before therapy initiation, and stratification to non-standard ALL was a risk factor. IOP reduction therapy was administered to 13 children (14%); none required surgery. Values normalised in all cases. On multivariate logistic regression analysis, dexamethasone therapy was a significant risk factor for ocular hypertension. High body mass index was an additional risk factor in children with elevated IOP at ALL diagnosis. Routine evaluation of IOP during steroid therapy is very important in children with ALL to ensure early intervention which may prevent permanent ocular damage.",

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author = "Shlomit Barzilai-Birenboim and Sarah Elitzur and Ronit Nirel and Miriam Ehrenberg and Alon Zahavi and Galia Avrahami and Gabbay, {Itay E.} and Gil Gilad and Gad Dotan and Shai Izraeli and Daood, {Rabeea Haj} and Noa Geffen",

note = "Funding Information: This work was supported by the Israeli Society of Paediatric Haemato-Oncology, the Israel Cancer Association, and Amutat Haim. Special thanks to Dina Kugel and Naomi Litichever, the data coordinators of the Israel National Study of Childhood ALL for their invaluable work, to Gioia Blayer of the Hebrew University for her help with the statistical analyses, and the English Language Service of Rabin Medical Center for editing of the manuscript. Funding Information: This work was supported by the Israeli Society of Paediatric Haemato‐Oncology, the Israel Cancer Association, and Amutat Haim. Special thanks to Dina Kugel and Naomi Litichever, the data coordinators of the Israel National Study of Childhood ALL for their invaluable work, to Gioia Blayer of the Hebrew University for her help with the statistical analyses, and the English Language Service of Rabin Medical Center for editing of the manuscript. Publisher Copyright: {\textcopyright} 2021 British Society for Haematology and John Wiley & Sons Ltd",

year = "2022",

month = mar,

doi = "10.1111/bjh.17987",

language = "American English",

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AU - Elitzur, Sarah

AU - Nirel, Ronit

AU - Ehrenberg, Miriam

AU - Zahavi, Alon

AU - Avrahami, Galia

AU - Gabbay, Itay E.

AU - Gilad, Gil

AU - Dotan, Gad

AU - Izraeli, Shai

AU - Daood, Rabeea Haj

AU - Geffen, Noa

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N2 - Most childhood acute lymphoblastic leukaemia (ALL) protocols include high-dose steroid therapy. However, the known potential of high-dose steroids to significantly elevate intraocular pressure (IOP) and lead to glaucomatous optic neuropathy has not been intensively investigated in children with ALL. Moreover, as children with ALL do not routinely undergo IOP measurements, the need for IOP monitoring and therapy is unknown. We prospectively measured IOP in 90 children with newly diagnosed ALL attending a tertiary paediatric haematology/oncology centre, at diagnosis and at the middle and end of induction therapy. Ocular hypertension (IOP > 21 mm Hg) at any time point was documented in 64 children (71%), and the prevalence increased during induction. Thirty-six children (40%) had elevated IOP at ALL diagnosis before therapy initiation, and stratification to non-standard ALL was a risk factor. IOP reduction therapy was administered to 13 children (14%); none required surgery. Values normalised in all cases. On multivariate logistic regression analysis, dexamethasone therapy was a significant risk factor for ocular hypertension. High body mass index was an additional risk factor in children with elevated IOP at ALL diagnosis. Routine evaluation of IOP during steroid therapy is very important in children with ALL to ensure early intervention which may prevent permanent ocular damage.

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ER -

Elevated intraocular pressure in children with acute lymphoblastic leukaemia: A prospective study

Abstract

Bibliographical note

Keywords

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