He Guo-Qian, Dai Yi-Ling, Jiang Ming-Yan, Gao Ju, Guo Xia
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Evid Based Complement Alternat Med. 2022 Mar 21;2022:7783823. doi: 10.1155/2022/7783823. eCollection 2022.
Relapse as the commonest treatment failure through chemotherapy of child presented with acute lymphoblastic leukemia (ALL) is usually within 3 years of remission. Central nervous system (CNS) is expected as a site of extramedullary relapse in 3-8% of child leukemia, often leading to a poor prognosis. A few patients may have headache and vomiting and can be diagnosed without difficulty. However, most patients present with asymptomatic conditions. Obesity has become one of the greatest reported complications of children ALL survivors. Rarely, obesity presentation can be the first manifestation of CNS leukemia. Here, we present three unusual cases with B-ALL presentation of obesity as the first symptom at the time of CNS relapse after achieving remission. This highly localized presentation is unusual and would hopefully inform clinicians to have a high index of suspicion for relapse in children with ALL.
复发是儿童急性淋巴细胞白血病（ALL）化疗最常见的治疗失败情况，通常发生在缓解后的3年内。中枢神经系统（CNS）预计是3%-8%儿童白血病髓外复发的部位，常导致预后不良。少数患者可能有头痛和呕吐，诊断并不困难。然而，大多数患者表现为无症状。肥胖已成为儿童ALL幸存者报告的最严重并发症之一。肥胖表现很少会是中枢神经系统白血病的首发表现。在此，我们报告三例不寻常的病例，这些病例中B-ALL在缓解后中枢神经系统复发时以肥胖作为首发症状。这种高度局限的表现并不常见，希望能提醒临床医生对ALL患儿的复发保持高度怀疑。
