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Posterior Reversible Encephalopathy Syndrome in Children with Malignancies or After Hematopoietic Cell Transplantation: A Polish Nationwide Study
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Tomasz Brzeski
1,*
,
Wanda Badowska
1,
Katarzyna Mycko
1,
Patrycja Tyszka
1,
Martyna Korzeniewicz
1,
Julia Kolodrubiec
2,
Wojciech Mlynarski
2,
Karolina Gawle-Krawczyk
3,
Katarzyna Koch
3,
Pawel Laguna
3,
Aleksandra Kiermasz
4,
Agnieszka Mizia-Malarz
4,
Marta Malczewska
5,
Katarzyna Drabko
5,
Anna Malecka
6,
Ninela Irga-Jaworska
6,
Patrycja Marciniak-Stepak
7,
Katarzyna Derwich
7,
Jacek Wachowiak
7,
Magdalena Bartnik
8,
Tomasz Ociepa
8,
Tomasz Urasinski
8,
Malgorzata Sawicka-Zukowska
9,
Maryna Krawczuk-Rybak
9,
Grzegorz Waliszczak
10,
Walentyna Balwierz
10,11,
Szymon Skoczen
10,11,
Tomasz Jarmolinski
12,
Krzysztof Kalwak
12,
Iwona Ruranska
13,
Tomasz Szczepanski
13,
Wioletta Bal
14,15,
Radosław Chaber
14,15,
Magdalena Tarasinska
16,
Bozenna Dembowska-Baginska
16,
Agnieszka Chodala-Grzywacz
17,
Grazyna Karolczyk
17,
Sonia Pajak
4,18,
Monika Richert-Przygonska
19,
Krzysztof Czyzewski
19 and
Jan Styczynski
19add
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1
Department of Pediatric Oncology and Hematology, University of Warmia and Mazury in Olsztyn, Regional Specialized Children’s Hospital, 10-561 Olsztyn, Poland
2
Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, 92-213 Lodz, Poland
3
Department of Pediatric Oncology and Hematology, Clinical Transplantology and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
4
Department of Pediatric Hematology and Oncology, Medical University of Silesia, 40-752 Katowice, Poland
5
Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-093 Lublin, Poland
6
Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-952 Gdansk, Poland
7
Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland
8
Department of Pediatrics and Hemato-Oncology USK1, Pomeranian Medical University, 71-252 Szczecin, Poland
9
Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Bialystok, Poland
10
Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland
11
Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Krakow, Poland
12
Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 20-529 Wrocław, Poland
13
Department of Pediatric Hematology and Oncology, Medical University of Silesia, 41-800 Zabrze, Poland
14
Department of Pediatrics, Faculty of Medicine, University of Rzeszow, 35-310 Rzeszow, Poland
15
Clinic of Pediatric Oncology and Hematology, State Hospital 2, 35-301 Rzeszow, Poland
16
Department of Oncology, Children’s Memorial Health Institute, 04-730 Warsaw, Poland
17
Department of Pediatric Hematology and Oncology, Regional Polyclinic Hospital in Kielce, 25-734 Kielce, Poland
18
Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland
19
Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(23), 3789; https://doi.org/10.3390/cancers17233789 (registering DOI)
Submission received: 4 November 2025
/
Revised: 19 November 2025
/
Accepted: 25 November 2025
/
Published: 26 November 2025
(This article belongs to the Section Pediatric Oncology)
Simple Summary
Posterior reversible encephalopathy syndrome (PRES) is a significant complication of oncological and transplant treatment in children. We present the results of a multicenter, nationwide study focusing on PRES in children treated for malignancies or undergoing hematopoietic cell transplantation. Clinical and laboratory abnormalities, management strategies, outcomes, and complications of PRES were analyzed. The occurrence of PRES had a negative impact on survival. We paid special attention to the prodromal period of PRES. In our opinion, this may be the key to its early diagnosis. We propose the predictive index, as well as diagnostic criteria and a new name for the syndrome, saving the existing acronym: we have shown that the disease can no longer be regarded as “reversible” and we propose the use of the word “rapid” in the PRES acronym.
Abstract
Background/Objectives: The objective of this study was to analyze the clinical and laboratory features, management, outcomes, and complications of PRES in children with malignancies or following hematopoietic cell transplantation (HCT). Methods: This was a multicenter retrospective analysis of PRES episodes diagnosed between 2014 and 2022 in Polish pediatric hematology and oncology (PHO) centers and HCT units. The study included 438 patients treated for malignancy or post-HCT: 120 with PRES (study group) and 318 without PRES (control group). Results: PRES was diagnosed in children aged 1.7–16.5 years (median = 7.7 years). The most common underlying diagnosis was ALL (76.7%; n = 92). Symptoms of PRES included disturbances of consciousness (84.2%), seizures (80.0%), hypertension (74.2%), apathy (64.2%), abdominal pain (45.0%), visual disturbances (28.3%), and headaches (26.7%). Electrolyte abnormalities were observed in 75.0% of children, most commonly hyponatremia (49.2%) and hypokalemia (37.5%). Children with PRES were more likely to require admission to the intensive care unit (ICU) than controls (50.0% vs. 29.6%, p < 0.001). The most frequent long-term complications of PRES were hypertension (22.5%) and epilepsy (20.8%). Among PHO patients, those with PRES had significantly lower DFS (76.7% vs. 93.7%, p < 0.001) and OS (79.2% vs. 93.4%, p < 0.001). In the HCT group, PRES was also associated with lower DFS (40.0% vs. 83.3%, p = 0.012) and OS (40.0% vs. 77.8%, p = 0.047). Conclusions: PRES is a significant complication of oncological and transplant treatment in children. Its occurrence was associated with worse overall and disease-free survival. We proposed a predictive index for PRES, diagnostic criteria, and a revised name for this syndrome.
Keywords:
PRES; children; pediatric oncology; HCT; predictive index; risk factors
