成人急性淋巴细胞白血病中枢神经系统白血病的诊断和处理  

The diagnosis and treatment of central nervous system leukemia in adults with acute lymphoblastic leukemia

作　　者：何静[1] 严晗[1] 胡豫[1] 刘新月[1] 胡俊斌[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院血液病研究所,武汉430022

出　　处：《临床血液学杂志》2017年第2期187-189,共3页Journal of Clinical Hematology

摘　　要：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 cure rates in adults with acute lymphoblastic leukemia （ALL） remain at only 30% to 40% and that of Ph-positive ALL is less than 20 %. Recurrence is a main obstacle to improve prognosis. Central nervous system （CNS） involvement at initial presentation decreases the overall survival. Without prophylaxis,the CNS re- currence reaches 30% of adult ALL in complete remission （CR） and the outcome is poor. But the diagnosis and treatment of central nervous system leukemia （CNSL） is easy to be ignored and this subject has not been addressed as thoroughly. In this article,we present a 49 years old female with Ph-positive ALL. She had CNS recurrence after achieved CR by treatment with imatinib plus chemotherapy without enough CNS prophylaxis. Then she attained CR again by intrathecal methotrexate and oral dasatinib plus low intense systemic chemotherapy. The performance, diagnosis and risk factors of CNSL,methods of CNSL prophylaxis and treatment in adult patients with ALL espe-cially Ph-positive cases are discussed.

关 键 词：白血病 淋巴细胞 急性 中枢神经系统白血病 诊断 治疗 

分 类 号：R733.71[医药卫生—肿瘤]