Maria B L, Dennis M, Obonsawin M
Department of Pediatrics, University of Florida College of Medicine, Gainesville 32610.
Can J Neurol Sci. 1993 Aug;20(3):199-205.
As survival rates for childhood acute lymphoblastic leukemia have increased, concerns over improved quality-of-life have also increased. Although 3-10% of children may experience acute transient neurotoxicity during induction chemotherapy, they are felt to be at low risk for late sequelae. We report three previously healthy boys with newly-diagnosed acute lymphoblastic leukemia who presented with obtundation and severe seizures during late induction with a standard four drug chemotherapy regimen. While all three are disease-free survivors, they unexpectedly have persistent and medically intractable partial complex seizures, broad-based neuropsychological impairment and striking neuroimaging abnormalities. These findings suggest that children with leukemia who develop an acute encephalopathy during induction chemotherapy are at risk for long-term neurological and neuropsychological sequelae, despite the cessation of further potentially neurotoxic therapy.
随着儿童急性淋巴细胞白血病存活率的提高，对生活质量改善的关注也在增加。尽管3%至10%的儿童在诱导化疗期间可能会经历急性短暂性神经毒性，但人们认为他们发生晚期后遗症的风险较低。我们报告了三名先前健康的新诊断为急性淋巴细胞白血病的男孩，他们在采用标准四联化疗方案进行诱导治疗后期出现了意识模糊和严重癫痫发作。虽然这三名患者均为无病幸存者，但他们意外地出现了持续性且药物难治性的部分复杂性癫痫发作、广泛的神经心理障碍以及明显的神经影像学异常。这些发现表明，尽管停止了进一步的潜在神经毒性治疗，但在诱导化疗期间发生急性脑病的白血病儿童仍有发生长期神经和神经心理后遗症的风险。
