Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies

Lindsey Murphy,1 Kelly Maloney,1,2 Lia Gore,1,2 Eliza Blanchette3 1Department of Pediatrics, Sections of Hematology/Oncology/Bone Marrow Transplant-Cellular Therapeutics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA; 2University of Colorado Cancer Center, Aurora, CO, USA; 3Department of Pediatrics, Section of Nephrology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USACorrespondence: Lia Gore Tel +17207776458Fax +17207777339Email lia.gore@cuanschutz.eduAbstract: Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outcomes for many children with ALL, the side effects and consequences of therapy are not to be underestimated. Hypertension is a well-known acute and chronic side effect of treatment for childhood ALL, although limited data are available regarding the prevalence of hypertension in children undergoing treatment for ALL. In this review of hypertension in pediatric ALL patients, we examine the existing data on incidence and prevalence during treatment and in pediatric ALL survivors. We describe independent risk factors for development of hypertension along with treatment-related causes. Long-term consequences and the risk to survivors of pediatric ALL are further defined. While many ALL patients require antihypertensive medications during some portion of their treatment, there are no clear guidelines on treating inpatient hypertension given challenges that exist in recognizing and managing hypertension in this setting and in this population. Here, we propose an algorithmic approach to diagnose and treat pediatric ALL patients with HTN, along with monitoring and continuation versus cessation of antihypertensive therapy as an outpatient.Keywords: hypertension, pediatric, leukemia, ALL, prevale