儿童中枢神经系统白血病的诊治进展

鉴于急性白血病联合化疗时血脑屏障的作用,白血病细胞逃避化疗药物的杀伤最终导致中枢神经系统白血病(central nervous system leukemia,CNSL)发生.目前诊断CNSL的标准主要是依赖于脑脊液(carebrospinal fluid,CSF)检查、临床表现和影像学检查,早期诊断方法有CSF细胞形态学检查、CT和MRI等影像学检查、CSF微小残留病的检测、检测CSF硫化氢含量、分子生物学指标的检测.CNSL的预防主要包括直接鞘内注射药物、可透过血脑屏障的全身化疗药物和放射疗法.CNSL的治疗主要包括化疗放疗、异基因造血干细胞的移植和靶向治疗.

The current diagnosis and treatment of central nervous system leukemia

Given the existence of the blood brain barrier when combined with chemotherapy in acute leukemia treatment, leukemia cells are ultimately resulted in the occurrence of central nervous system leukemia (CNSL)by escaping the damage of chemotherapy drugs.At present,CNSL diagnostic criteria mainly relies on cerebrospinal fluid examination, clinical presentation and imaging examination.There are many means that contribute to early diagnosis of CNSL, which comprise cerebrospinal fluid cytology, CT and MRI and other imaging, monitoring minimal residual disease (MRD) in cerebrospinal fluid, monitoring hydrogen sulfide in cerebrospinal fluid, testing molecular biomarker indicators.There are several methods of achieving the goal of prevention of CNSL, including direct intrathecal administration of chemotherapy, systemic administration of chemotherapy able to penetrate the blood-brain barrier, and cranial radiation.The treatment of CNSL includes chemotherapy and radiotherapy, allogeneic hematopoietic stem cell transplantation and targeted therapy.