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成人急性淋巴细胞白血病(ALL)总体疗效仍不能令人满意,特别是Ph(+)ALL预后最差。除了探索新的治疗方案,规范治疗是提高生存率的重要手段。成人ALL易发生中枢神经系统累及和中枢神经系统白血病(CNSL)复发。如果不进行充足的CNSL预防,CNSL复发率高,影响患者生存。酪氨酸激酶抑制剂(TKI)的应用改变了Ph(+)ALL的治疗模式,有望使其预后全面改观。但如何选择TKI,如何联用化疗,能否替代造血干细胞移植都是需要进一步研究的问题。通过文中讨论的病例,希望能使读者对成人ALL CNSL的诊断、预防和治疗有一个全面的认识,从而达到规范诊治,提高此类患者的生存率。
The overall efficacy of adult acute lymphoblastic leukemia (ALL) remains unsatisfactory, especially in the case of Ph (+) ALL with the poorest prognosis. In addition to exploring new treatment options, standardizing treatment is an important means of improving survival. Adult ALL prone to central nervous system involvement and central nervous system leukemia (CNSL) recurrence. Without adequate CNSL prophylaxis, CNSL has a high recurrence rate and affects patient survival. The use of tyrosine kinase inhibitors (TKIs) has altered the treatment pattern of Ph (+) ALL and is expected to have an overall prognosis. However, how to choose TKI, how to use chemotherapy, can replace hematopoietic stem cell transplantation are issues that need further study. Through the cases discussed in the article, I hope that readers can have a comprehensive understanding of the diagnosis, prevention and treatment of adult ALL CNSL in order to achieve standardized diagnosis and treatment and improve the survival rate of such patients.