Schwartz C L, Miller N R, Wharam M D, Leventhal B G
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Cancer. 1989 Apr 15;63(8):1616-20. doi: 10.1002/1097-0142(19890415)63:8<1616::aid-cncr2820630829>3.0.co;2-y.
Three children with acute lymphoblastic leukemia (ALL) developed isolated optic nerve relapse as the initial site of disease recurrence. They were part of an early cohort of 39 children with non-B-cell, non-T-cell ALL without central nervous system (CNS) involvement, treated regardless of initial leukocyte count with intrathecal chemotherapy for CNS prophylaxis. Although the optic nerve is a known site of relapse in patients with systemic and meningeal ALL, it has not been reported to occur in otherwise relapse-free patients. Early diagnosis and treatment prevented blindness and allowed for long-term survival (57+, 49+, and 97+ months, respectively) and possibly cure. Since these patients were treated in a new manner and exhibited a new pattern of relapse, their clinical courses were reviewed. Features considered worrisome, but not diagnostic of CNS leukemia may be of greater import when intrathecal medications are utilized as primary CNS prophylaxis. An expanded definition of CNS leukemia may be necessary.
三名急性淋巴细胞白血病（ALL）患儿出现孤立性视神经复发，作为疾病复发的初始部位。他们是39名非B细胞、非T细胞ALL且无中枢神经系统（CNS）受累患儿的早期队列的一部分，无论初始白细胞计数如何，均接受鞘内化疗以预防CNS。尽管视神经是系统性和脑膜ALL患者已知的复发部位，但尚未报道在其他方面无复发的患者中出现。早期诊断和治疗预防了失明，并实现了长期生存（分别为57 +、49 +和97 +个月），甚至可能治愈。由于这些患者采用了新的治疗方式并表现出一种新的复发模式，因此对他们的临床病程进行了回顾。当使用鞘内药物作为主要的CNS预防措施时，那些令人担忧但不能诊断为CNS白血病的特征可能具有更重要的意义。可能需要扩大CNS白血病的定义。
