Cole Peter D, Kamen Barton A
Department of Pediatrics and Pharmacology, Robert Wood Johnson Medical School/UMDNJ, The Cancer Institute of New Jersey, New Brunswick, New Jersey 08901, USA.
Ment Retard Dev Disabil Res Rev. 2006;12(3):174-83. doi: 10.1002/mrdd.20113.
Most children diagnosed today with acute lymphoblastic leukemia (ALL) will be cured. However, treatment entails risk of neurotoxicity, causing deficits in neurocognitive function that can persist in the years after treatment is completed. Many of the components of leukemia therapy can contribute to adverse neurologic sequelae, including craniospinal irradiation, nucleoside analogs, corticosteroids, and antifolates. In this review, we describe the characteristic radiographic findings and neurocognitive deficits seen among survivors of childhood ALL. We summarize what is known about the pathophysiology of delayed treatment-related neurotoxicity, with a focus on the toxicity resulting from pharmacologic disruption of folate physiology within the central nervous system. Finally, we suggest testable strategies to ameliorate the symptoms of treatment-related neurotoxicity or decrease its incidence.
如今，大多数被诊断为急性淋巴细胞白血病（ALL）的儿童都将被治愈。然而，治疗存在神经毒性风险，会导致神经认知功能缺陷，这些缺陷在治疗结束后的数年里可能持续存在。白血病治疗的许多组成部分都可能导致不良神经后遗症，包括颅脑脊髓照射、核苷类似物、皮质类固醇和抗叶酸药物。在这篇综述中，我们描述了儿童ALL幸存者中可见的特征性影像学表现和神经认知缺陷。我们总结了关于延迟的治疗相关神经毒性病理生理学的已知情况，重点关注中枢神经系统内叶酸生理药理学破坏所导致的毒性。最后，我们提出了可验证的策略，以改善治疗相关神经毒性的症状或降低其发生率。
