Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
University of Kansas Medical Center, Kansas City, KS, USA.
Leuk Lymphoma. 2023 Dec;64(12):2002-2007. doi: 10.1080/10428194.2023.2248331. Epub 2023 Aug 17.
We evaluated outcomes of AML patients with central nervous system (CNS) involvement at two academic institutions. Fifty-two adult patients were identified. Neurologic symptoms were reported in 69% of patients, with headache the most common (33%). 84% ( = 42) of patients cleared their cerebrospinal fluid (CSF), with a median number of one dose of intrathecal (IT) chemotherapy. Of these patients, 21% ( = 9) had a CSF relapse, with 67% ( = 6) of those experiencing CSF relapse also having concurrent bone marrow relapse. Of the 36 patients with baseline neurologic symptoms, 69% had improvement in symptoms post-IT therapy. The median overall survival was 9.3 months and 3.5 months for patients with CNS involvement diagnosed before/during induction and at relapse, respectively. In this study, IT therapy was rapidly effective in clearing CSF blasts and improving neurologic symptoms in most patients. Few patients experienced CSF relapse, which predominantly occurred in the setting of concomitant bone marrow relapse.
我们在两所学术机构评估了中枢神经系统（CNS）受累的 AML 患者的结局。共确定了 52 例成年患者。69%的患者有神经系统症状，最常见的是头痛（33%）。84%（ = 42）的患者脑脊液（CSF）得到缓解，中位数使用了一次鞘内（IT）化疗。这些患者中有 21%（ = 9）出现 CSF 复发，其中 67%（ = 6）的 CSF 复发患者同时伴有骨髓复发。在基线时有神经系统症状的 36 例患者中，69%的患者在 IT 治疗后症状有所改善。有 CNS 受累的患者中位总生存期分别为 9.3 个月和 3.5 个月，诊断为诱导前/诱导时和复发时。在这项研究中，IT 治疗在清除 CSF 白血病细胞和改善大多数患者的神经系统症状方面迅速有效。少数患者出现 CSF 复发，主要发生在骨髓复发的情况下。
