Consensus recommendations on diagnosis and management of posterior reversible encephalopathy syndrome in paediatric haematopoietic stem cell transplantation
In brief
Experts reach consensus on 38 recommendations for PRES after pediatric stem cell transplant
An international multidisciplinary panel agreed on 38 recommendations for diagnosing, managing and following posterior reversible encephalopathy syndrome (PRES) in children after allogeneic stem cell transplant. The guidance covers early recognition, neuroimaging, blood pressure and immunosuppressive treatment, and neurological follow-up; whether using it improves patient outcomes remains to be tested.
- Journal
- British journal of haematology (Q1)
- Published
- 1 November 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Leardini D, Bergonzini L, Muratore E, Pace V, Cacace F, Barrui V, et al.
- PMID
- 42968593
- DOI
- 10.1111/bjh.70873
Why clinicians should know about it
- Picked for Hematology (top studies of the week, 8 November 2026): Consensus guidance for PRES management in paediatric HSCT recipients
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a rare but potentially life-threatening neurological complication following paediatric allogeneic haematopoietic stem cell transplantation (HSCT). Its heterogeneous presentation and the absence of standardized guidance contribute to variability in diagnosis and management. The aim was to develop multidisciplinary, consensus-based recommendations for the diagnosis, management and follow-up of PRES in paediatric allogeneic HSCT recipients. A modified Delphi process was conducted between February and September 2025. An international panel comprising transplant physicians, neurologists, neuro-oncologists and neuroradiologists participated in four iterative rounds. A systematic literature review informed statement development across five domains: pathogenesis, clinical features, diagnostics, management and follow-up. Predefined agreement thresholds determined consensus. Thirty-eight statements achieved consensus in the first round, indicating strong agreement. Key recommendations addressed risk factors, early clinical recognition, appropriate neuroimaging and management of contributory factors including hypertension and immunosuppressive therapy. Emphasis was placed on multidisciplinary care, prompt diagnosis and tailored management. Guidance on neurological monitoring and long-term follow-up was also established. These consensus recommendations provide a standardized framework for the management of PRES in paediatric allogeneic HSCT recipients. Their implementation may improve early recognition, optimize treatment and enhance outcomes, while highlighting priorities for future research and prospective guideline development.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.