Larson Richard A
a Department of Medicine, Section of Hematology/Oncology, and Comprehensive Cancer Center , The University of Chicago , Chicago , IL , USA.
Leuk Lymphoma. 2018 Jan;59(1):3-13. doi: 10.1080/10428194.2017.1326597. Epub 2017 May 23.
The central nervous system (CNS) is an important site of involvement by acute lymphoblastic leukemia (ALL) in adults. The prevalence is sufficiently high that prophylactic treatment is routinely given to this sanctuary site in order to eradicate occult disease that might otherwise lead to a relapse. A lumbar puncture should be routinely performed in all newly diagnosed patients with ALL. The risks of CNS leukemia vary by phenotype and genotype. Preventive treatment of the CNS during post-remission therapy has become an integral part of all current ALL treatment protocols. Most treatment regimens combine multiple doses of intrathecal chemotherapy with high-dose systemic methotrexate and/or cytarabine. Cranial irradiation is less commonly used for prophylaxis but is still the most effective treatment for overt CNS leukemia. Recurrences within the CNS usually coincide with or predict soon afterwards for systemic relapse in the marrow and blood.
中枢神经系统（CNS）是成人急性淋巴细胞白血病（ALL）累及的重要部位。其患病率足够高，以至于通常会对这个“庇护所”部位进行预防性治疗，以根除可能导致复发的隐匿性疾病。所有新诊断的ALL患者都应常规进行腰椎穿刺。中枢神经系统白血病的风险因表型和基因型而异。缓解后治疗期间对中枢神经系统的预防性治疗已成为所有当前ALL治疗方案的一个组成部分。大多数治疗方案将多剂量鞘内化疗与大剂量全身甲氨蝶呤和/或阿糖胞苷联合使用。颅脑照射较少用于预防，但仍然是显性中枢神经系统白血病最有效的治疗方法。中枢神经系统内的复发通常与骨髓和血液中的全身复发同时发生或预示不久后会发生全身复发。
