Dr Sabina Yesmin, Assistant Registrar, Department of Neurosurgery, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2022 Jan;31(1):55-60.
The most common malignant neoplasm in Childhood is Leukemia which is about 41% of all malignancies. Incidence of CNS involvement is less than 5% in Acute Lymphoblastic Leukemia and 6-29% in Acute Myeloblastic Leukemia at Diagnosis. For Successful treatment of childhood leukemia it is mandatory, to give sufficient therapy directed to the CNS to treat sub clinical or overt CNS Leukemia. Without Central Nervous System- Directed therapy, relapses originating from the CNS in up to 75% cases. For this purpose it is crucial to find out the CNS involvement in acute leukemia at diagnosis. This study was conducted to find proportion and pattern of central nervous system involvement (central nervous system manifestation and/or cerebrospinal fluid findings) in acute leukemia at diagnosis in Bangladesh. A cross sectional study was conducted from May 2012 to November 2012 in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 50 samples were included those having age <15 years newly diagnosed with acute leukemia by purposive sampling. Common age group 1-5 years (48%), 32 patients (64%) were male and 18 patients (36%) were female. Out of 32 male patients 4 patients presented with CNS manifestation and among 18 female patients 2 patients presented with CNS manifestation. There is no association between sex and CNS presentation (P value 0.89). 25 (50%) patients had total leukocyte count >11,000-1,00,000. Twelve (24%) patients had total leukocyte count <4,000. Eight (16%) patients had total leukocyte count 4,000-11,000, and rest 05(10%) patients had leukocyte count >1,00,000. Proportion of CNS manifestation was found 6/50 patients. Eight (8) patients were suffering from AML and 42 patients were suffering form ALL. Among 8 AML patients 1 (11.1%) patient had CNS manifestation and Among 42 ALL patients 5(11.1%) patients had CNS manifestation. Out of 6 patients with CNS manifestation, 2 (04%) patients presented with clinical manifestation, and 5(10%) had positive CSF findings. Pattern of CSF finding of 50 leukemic children CNS-1 90%, CNS-2 02%, CNS-3 08%, and no patients had traumatic lumber puncture with concomitant presence of blasts cells. There is significant association was found between hyper leukocytosis and CNS manifestation (p=0.138) but there is no statistically significant association between positive CSF findings and neurological findings (p=0.082). At conclusion, CNS manifestation is not uncommon (6/50 patients) was found in acute leukemia at diagnosis. So, every patient of acute leukemia should be examined carefully for CNS involvement along with CSF cytospin.
在儿童中，最常见的恶性肿瘤是白血病，约占所有恶性肿瘤的 41%。在急性淋巴细胞白血病中，中枢神经系统受累的发生率小于 5%，在急性髓细胞白血病中为 6-29%。为了成功治疗儿童白血病，必须对中枢神经系统进行充分的治疗，以治疗亚临床或显性中枢神经系统白血病。如果没有中枢神经系统定向治疗，高达 75%的病例会从中枢神经系统复发。为此，在诊断急性白血病时，必须确定中枢神经系统受累情况。本研究旨在确定孟加拉国急性白血病诊断时中枢神经系统受累（中枢神经系统表现和/或脑脊液结果）的比例和模式。这是一项 2012 年 5 月至 11 月在孟加拉国达卡的 Bangabandhu Sheikh Mujib 医科大学儿科血液学和肿瘤学系进行的横断面研究。共纳入 50 例年龄<15 岁、经明确诊断为急性白血病的患者。常见年龄组为 1-5 岁（48%），32 例患者（64%）为男性，18 例患者（36%）为女性。在 32 名男性患者中，有 4 名出现中枢神经系统表现，在 18 名女性患者中，有 2 名出现中枢神经系统表现。性别与中枢神经系统表现之间无关联（P 值 0.89）。25 例（50%）患者的总白细胞计数>11,000-1,000,000。12 例（24%）患者的总白细胞计数<4,000。8 例（16%）患者的总白细胞计数为 4,000-11,000，其余 05 例（10%）患者的白细胞计数>1,000,000。发现有 6/50 例患者出现中枢神经系统表现。8 例（8）患者患有 AML，42 例患者患有 ALL。在 8 例 AML 患者中，有 1 例（11.1%）患者出现中枢神经系统表现，在 42 例 ALL 患者中，有 5 例（11.1%）患者出现中枢神经系统表现。在 6 例有中枢神经系统表现的患者中，有 2 例（04%）出现临床表现，有 5 例（10%）有阳性脑脊液发现。50 例白血病患儿的 CSF 检查结果模式为 CNS-1 90%，CNS-2 02%，CNS-3 08%，无患者因伴有髓母细胞瘤细胞的创伤性腰椎穿刺而出现脑脊液异常。高白细胞血症与中枢神经系统表现之间存在显著相关性（p=0.138），但脑脊液阳性发现与神经系统表现之间无统计学显著相关性（p=0.082）。总之，在急性白血病的诊断中，发现中枢神经系统表现并不罕见（6/50 例）。因此，对所有急性白血病患者都应仔细检查中枢神经系统受累情况，同时进行脑脊液细胞涂片检查。
