Service of Pediatric Hematology, Materno Infantil Hospital, Badajoz, Spain.
Crit Rev Oncol Hematol. 2012 Nov;84(2):274-86. doi: 10.1016/j.critrevonc.2012.04.003. Epub 2012 May 11.
In the last decades, increasing success rates are being obtained in the chemotherapy of pediatric leukemia and lymphoma. However, the cornerstone of this treatment is still formed by a reduced number of drugs with a highly toxic profile. In particular, central nervous system complications remain a challenging clinical problem, requiring rapid detection and prompt treatment to limit permanent damage. Furthermore, clinicians are often challenged to discriminate between CNS involvement by the disease, toxicity of drugs or infections. This clinically oriented review will help recognize and handle the main neurologic adverse effects induced by chemotherapy in pediatric patients with lymphoblastic leukemia/lymphoma. Different clinical entities and putative drugs involved are discussed in each chapter, with clinical cases illustrating the most relevant and challenging events. In addition, specific clinical-radiological patterns of some of these neurologic events are detailed. Finally, the role of pharmacogenetics, with special focus on those polymorphisms that could help explain the occurrence of neurotoxicity, is also discussed.
在过去的几十年中，儿科白血病和淋巴瘤的化疗成功率不断提高。然而，这种治疗的基石仍然是少数几种具有高度毒性特征的药物。特别是，中枢神经系统并发症仍然是一个具有挑战性的临床问题，需要快速检测和及时治疗，以限制永久性损伤。此外，临床医生经常面临着区分疾病、药物毒性或感染引起的中枢神经系统受累的挑战。本临床导向的综述将有助于识别和处理儿童急性淋巴细胞白血病/淋巴瘤患者化疗引起的主要神经不良反应。在每一章中讨论了不同的临床实体和可能涉及的药物，并通过临床病例说明了最相关和最具挑战性的事件。此外，还详细介绍了其中一些神经事件的特定临床-放射学模式。最后，还讨论了药物遗传学的作用，特别关注那些可能有助于解释神经毒性发生的多态性。
