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目的通过对中枢神经系统白血病(CNSL)的防治,预防和降低白血病的髓外复发机会,提高儿童急性淋巴细胞性白血病(ALL)的长期生存。方法1999～2003年上海市新华医院对277例儿童ALL的诱导治疗期4～5次鞘内三联注射(甲氨蝶呤、阿糖胞苷、地塞米松),巩固期后采用大剂量甲氨蝶呤(HD-MTX)24h静脉连续滴注,进入维持后,每3个月1次,总共8～9次,以后改为鞘内注射3个月1次,直至化疗结束,对于超高危ALL患儿(白细胞计数>100×109/L、Ph1染色体阳性)采用头颅照射加鞘内注射。结果277例ALL患儿发生CNSL9例,发生率为3.2%,9例CNSL中4例骨髓复发,5例存活,中位生存时间22.2个月。结论CNSL的防治方法,明显降低了CNSL的发生率,使ALL患儿生存机会提高。发生CNSL的不利因素有高白细胞血症、T细胞性ALL、Ph1阳性染色体改变等。
Objective To improve the long-term survival of children with acute lymphoblastic leukemia (ALL) by preventing and treating central nervous system leukemia (CNSL), preventing and reducing extramedullary recurrence of leukemia. Methods From January 1999 to April 2003, Shanghai Xinhua Hospital injected intrathecal triple injection (methotrexate, cytarabine, dexamethasone) of 277 children with ALL for 4 to 5 days. Vein (HD-MTX) 24h continuous intravenous infusion, into the maintenance, once every 3 months, a total of 8 to 9 times, later changed to intrathecal injection of 3 months 1, until the end of chemotherapy, for high-risk ALL Children (white blood cell count> 100 × 109 / L, Ph1 chromosome positive) using head irradiation plus intrathecal injection. Results The incidence of CNSL in 277 children with ALL was 3.2%. In 9 CNSL cases, 4 cases had bone marrow recurrence, 5 cases survived, and the median survival time was 22.2 months. Conclusion The prevention and treatment of CNSL significantly reduces the incidence of CNSL and improves the survival chance of children with ALL. Adverse factors of CNSL occur are hyperleukemia, T-cell ALL and Ph1-positive chromosome changes.