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急性白血病(AL)中枢神经系统受累,称中枢神经系统白血病(CNSL),发生在AL任何时期,以急性淋巴细胞白血病(ALL)居高。初发时高白细胞计数、有明显髓外侵润、某些类型如M4、M5a、T细胞型、成熟Burkitt型、复发M3及有t(4;11)、Ph+遗传学特征都是CNSL高危发病因素。脑脊液(CSF)涂片中找到白血病细胞最具诊断意义。CSF白细胞>5个/μL,伴有CNS异常表现即可诊断CNSL。对CSF进一步分类有助于ALL分层治疗。CNSL治疗重在预防,常用的防治方法有鞘内化疗、全身系统治疗以及放射治疗。现代治疗模式不再强调放疗的作用,中大剂量化疗药物的早期使用可有效防治CNSL。
Acute leukemia (AL) involvement of the central nervous system, called CNSL, occurs at any stage of AL and is consistently elevated in acute lymphoblastic leukemia (ALL). The number of high white blood cells in the first episode was significantly higher than that in the non-CNSL group, with obvious extramedullary infiltrates. Some of the genotypes were M4, M5a, T cell type, mature Burkitt type, relapsed M3 and t (4; 11) factor. Leukemic cells found in cerebrospinal fluid (CSF) smears are most diagnostic. CSF white blood cells> 5 / μL, accompanied by CNS abnormalities can be diagnosed CNSL. Further classification of CSF contributes to stratification of ALL. CNSL treatment focuses on prevention, commonly used methods of prevention and treatment of intrathecal chemotherapy, systemic treatment and radiation therapy. Modem treatment is no longer emphasized the role of radiotherapy, early use of large doses of chemotherapy drugs can effectively prevent CNSL.