儿童急性白血病中枢神经系统浸润的防治进展

中枢神经系统白血病(CNSL)是儿童急性白血病(AL)复发的根源和治疗的难点,CNSL的预防和治疗已成为儿童AL治疗的关键之一。CNSL可发生在AL的任何时期,以急性淋巴细胞白血病(ALL)患者最多见。其高危发病因素有初发病时高白细胞、有明显的髓外浸润表现、T细胞型、成熟B细胞型、有t(4,11)或Ph+遗传学特征等。脑脊液涂片发现白血病细胞最具诊断意义。CNSL的治疗重点在于预防,主要的治疗方法有鞘注化疗、全身系统化疗、及头颅放疗。已有越来越多的学者认为,以有效、系统的个体化化疗及理想的鞘内治疗为基础,而不再强调放射治疗,不会影响AL患儿的长期生存率。

Progress on prevention and treatment of acute leukemia in children with central nervous system infiltration

Central nervous system leukemia （CNSL） is the root cause of relapse and the difficulty of treatment in children acute leukemia （AL）. Prevention and treatment of CNSL become one of the key treatment of acute leukemia in children.CNSL can occer at any stage of AL. Acute lymphocytic leukemia （ALL） is the most common type of leukemia with CNS involvement.There are several high risk factors associated with occerence of CNSL, including hyperleukocytosis at diagnosis, presence of extramedullary infiltration, some type of AL like T-cell immunophenotype, Burkitt＇s lymphnoma, high-risk genetic abnormalities such as t （4,11） and the Philadephia chromosome-positive.The presence of leukemic cells in cerebrospinal fluid （CSF） has importment diagnostic value. The key to CNSL therapy is prophylaxis, including intrathecal chemotherapy, systemic chemotherapy and radiation therapy.Most scholars believe that： individual systemic chemotherapy and intratheeal chemotherapy rather than emphasize radiation thrapy does not affect the long-term survival of patients with acute leukemia.