Stewart D J, Keating M J, McCredie K B, Smith T L, Youness E, Murphy S G, Bodey G P, Freireich E J
Cancer. 1981 Jan 1;47(1):184-96. doi: 10.1002/1097-0142(19810101)47:1<184::aid-cncr2820470130>3.0.co;2-m.
Central nervous system (CNS) involvement occurred in 45 of 222 (20.3%) leukemic adults achieving bone marrow (BM) complete remission (CR), including 12 of 23 (52%) acute undifferentiated leukemia (AUL), 12 of 32 (39%) lymphoma leukemia, 5 of 26 (19%) acute lymphoblastic leukemia, and 16 of 142 (11%) acute myelogenous leukemia. Risk factors for CNS disease were lactic dehydrogenase (LDH) greater than or equal to 25,000/mm3. AUL morphology, age less than 20 years, and extramedullary involvement were most significant. Pattern of CNS involvement varied with morphology. Survival after CNS relapse depended most on BM status and symptoms. Duration of CNS CR was longest for asymptomatic patients with low CSF cell counts. Also important were duration of first BM CR, ease of achievement of initial BM CR, and leukocyte count (original and at most closely antecedent BM involvement), reflecting the common origin of BM and CNS leukemic cells. Central nervous system relapse generally did not shorten BM CR or survival, although early primary CNS relapse was associated with early BM relapse.
在222例达到骨髓完全缓解（CR）的白血病成年患者中，有45例（20.3%）发生中枢神经系统（CNS）受累，其中包括23例急性未分化白血病（AUL）中的12例（52%）、32例淋巴瘤白血病中的12例（39%）、26例急性淋巴细胞白血病中的5例（19%）以及142例急性髓细胞白血病中的16例（11%）。CNS疾病的危险因素为乳酸脱氢酶（LDH）大于或等于25,000/mm³。AUL形态、年龄小于20岁以及髓外受累最为显著。CNS受累模式因形态而异。CNS复发后的生存主要取决于骨髓状态和症状。脑脊液细胞计数低的无症状患者CNS CR持续时间最长。首次骨髓CR持续时间、初次骨髓CR的难易程度以及白细胞计数（原始计数和最接近先前骨髓受累时的计数）也很重要，这反映了骨髓和CNS白血病细胞的共同起源。中枢神经系统复发一般不会缩短骨髓CR或生存期，尽管早期原发性CNS复发与早期骨髓复发相关。
