儿童急性淋巴细胞白血病中枢神经系统复发的

尽管针对儿童急性淋巴细胞白血病（ALL）中枢神经系统（CNS）的直接治疗较成功，但儿童应用标准鞘内预防性化疗却出现累及CNS的ALL复发仍持续在5-10%之间。本研究旨在评估常规脑脊液（CSF）分析在ALL治疗中的诊断价值。结果显示，研究共纳入例儿童ALL患者，其中31例（6.6%）出现累及CNS的ALL复发。22例患儿出现独立的CNS复发，9例患儿出现骨髓和CNS复发。在独立CNS复发患儿中，73%（16/22）是基于无症状患儿的常规CSF样本来诊断的。相反的，89%（8/9）的骨髓和CNS复发患者出现临床症状及体征并提示医师进行CSF检测。结果表明，腰椎穿刺鞘内化疗时的常规CSF检测是一项有效监测CNS复发的方法。

该研究正式发表于年12月《儿童血液肿瘤》杂志上（PediatrBloodCancer.Dec;61(12):-7）。

Diagnosisofcentralnervoussystemrelapseofpediatricacutelymphoblasticleukemia:ImpactofroutinecytologicalCSFanalysisatthetimeofintrathecalchemotherapy.

GassasA(1),KruegerJ,AlviS,SungL,HitzlerJ,LiebermanL.

BACKGROUND:Despitethesuccessofcentralnervoussystem(CNS)directedtherapyinpediatricacutelymphoblasticleukemia(ALL),relapseinvolvingtheCNScontinuestobeobservedin5-10%ofchildrenwhenutilizingstandardintrathecalprophylacticchemotherapy.WhilemostpediatricALLtreatmentprotocolsmandateregularlumbarpunctures(LP)fortheintrathecalinjectionofchemotherapy,thevalueofroutinecytologicalanalysisofcerebrospinalfluid(CSF)duringtherapyisunknown.OurobjectivewastoassessthediagnosticvalueofroutineCSFanalysisduringALLtherapy.PROCEDURE:Toallowforatleast10yearsoffollowupfromALLdiagnosis,children(0-18years)withALLdiagnosedandtreatedatSickKids,Toronto,Canadabetween-werestudied.MedicalrecordsofpatientswithCNSrelapsewereexaminedtodeterminewhetherCNSrelapsewasdiagnosedbasedoncytologyofaroutinelyobtainedCSFsample,aCSFsampleobtainedbecauseofsignsandsymptomsoraCSFsampleobtainedafterthediagnosisofabonemarrowrelapse.RESULTS:OfchildrentreatedforALL,31(6.6%)developedarelapseofALLinvolvingtheCNS.Twenty-twohadanisolatedCNSrelapseandninehada







































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