Bien Ewa, Stachowicz-Stencel Teresa, Szalewska Magdalena, Krawczyk Malgorzata, Synakiewicz Anna, Dubaniewicz-Wybieralska Miroslawa, Zielinski Piotr, Adamkiewicz-Drozynska Elzbieta, Balcerska Anna
Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk, 7. Debinki Street, 80-211 Gdansk, Poland.
Childs Nerv Syst. 2009 May;25(5):619-26. doi: 10.1007/s00381-009-0838-2. Epub 2009 Mar 20.
Malignant high-grade gliomas are the most common secondary neoplasms in children cured of acute lymphoblastic leukaemia (ALL). Although many predisposing factors exist (including systemic or intrathecal chemotherapy, young age, brain infiltration and genetic predispositions), cranial irradiation appears to be the strongest one.
Three cases of secondary high-grade gliomas (two multiform glioblastomas, grade IV; one anaplastic astrocytoma, grade III) developed in ALL survivors (F-M, 1:2) 3 to 6.3 years after stopping ALL therapy according to BFM-90 trial.
All tumours were supratentorial, contrast-enhancing, space-occupying, highly advanced and aggressive. Possible risk factors and current therapeutic options for paediatric ALL and malignant gliomas are reviewed and discussed.
Prognosis in secondary malignant gliomas in children is poor (overall survival of 5, 10 and 19 months) despite intense therapy. Thus, protocols for paediatric ALL reduce prophylactic cranial irradiation in favour of intrathecal and intravenous high-dose MTX. Nevertheless, ALL survivors must undergo systematic, long-term surveillance for early detection of intracranial neoplasms.
恶性高级别胶质瘤是急性淋巴细胞白血病（ALL）治愈儿童中最常见的继发性肿瘤。尽管存在许多诱发因素（包括全身或鞘内化疗、年龄小、脑浸润和遗传易感性），但颅脑照射似乎是最强的诱发因素。
3例继发性高级别胶质瘤（2例多形性胶质母细胞瘤，IV级；1例间变性星形细胞瘤，III级）发生在ALL幸存者（女∶男=1∶2）中，这些幸存者按照BFM - 90试验停止ALL治疗3至6.3年后发病。
所有肿瘤均位于幕上，有强化、占位效应，高度进展且侵袭性强。对儿童ALL和恶性胶质瘤可能的危险因素及当前的治疗选择进行了综述和讨论。
尽管进行了强化治疗，但儿童继发性恶性胶质瘤的预后较差（总生存期分别为5、10和19个月）。因此，儿童ALL方案减少了预防性颅脑照射，转而采用鞘内和静脉高剂量甲氨蝶呤。然而，ALL幸存者必须接受系统的长期监测，以便早期发现颅内肿瘤。
