Barredo Julio, Ritchey A Kim
Division of Pediatric Hematology/Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Pediatr Hematol Oncol. 2010 Aug;27(5):329-32. doi: 10.3109/08880011003758422.
The central nervous system (CNS) has long been recognized as a site, indeed a sanctuary, for leukemic cells. Although few (<5%) patients with acute lymphoblastic leukemia (ALL) actually present with overt CNS leukemia, without prophylactic CNS-directed treatment, over 50% will develop CNS disease. However, with modern CNS prophylaxis, the incidence of CNS relapse has been reduced to 6% or less. Although great progress has been made, we continue to struggle with management of CNS leukemia. This commentary will address issues of CNS leukemia treatment at diagnosis and at relapse. Topics that will be addressed include (1) CNS 2 status at diagnosis-definition and treatment; (2) CNS leukemia at diagnosis--treatment with radiation therapy; (3) isolated relapse of leukemia in the CNS--treatment of early and late relapse; and (4) opportunities for future research in CNS relapse of ALL.
长期以来，中枢神经系统（CNS）一直被认为是白血病细胞的一个部位，实际上是一个庇护所。虽然很少（<5%）急性淋巴细胞白血病（ALL）患者实际表现为明显的中枢神经系统白血病，但如果不进行预防性的中枢神经系统定向治疗，超过50%的患者会发生中枢神经系统疾病。然而，采用现代中枢神经系统预防措施后，中枢神经系统复发的发生率已降至6%或更低。尽管已经取得了巨大进展，但我们在中枢神经系统白血病的管理方面仍面临挑战。本评论将探讨诊断时和复发时中枢神经系统白血病的治疗问题。将讨论的主题包括：（1）诊断时的CNS 2状态——定义和治疗；（2）诊断时的中枢神经系统白血病——放射治疗；（3）中枢神经系统白血病的孤立复发——早期和晚期复发的治疗；以及（4）ALL中枢神经系统复发的未来研究机会。
