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Central nervous system disease in acute lymphoblastic leukemia: prophylaxis and treatment.

Abstract
Improved treatment for acute lymphoblastic leukemia (ALL) has virtually eliminated testicular relapse. However, the control of central nervous system (CNS) leukemia remains a therapeutic challenge in childhood ALL, partly because of the late complications arising from cranial irradiation. In most current pediatric protocols, cranial irradiation (12 to 18 Gy) is given to 5% to 25% of patients--those with T-cell ALL, overt CNS disease (CNS3 status) or high-risk cytogenetics. CNS control is a less urgent concern in adults with ALL, in whom systemic relapse remains the major problem. With current approaches, approximately 2% to 10% of patients can be expected to develop CNS relapse. Children with B-cell precursor ALL who have a late CNS relapse (after an initial remission of 18 months or more) and did not receive cranial irradiation have an excellent outcome after retrieval therapy, with a 5-year event-free survival (EFS) rate approaching that in newly diagnosed patients. Innovative treatment options are needed for children who develop CNS relapses after a short initial remission or after receiving cranial irradiation, and in any adults with CNS leukemia at diagnosis or relapse.
AuthorsChing-Hon Pui
JournalHematology. American Society of Hematology. Education Program (Hematology Am Soc Hematol Educ Program) Pg. 142-6 ( 2006) ISSN: 1520-4391 [Print] United States
PMID17124053 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)
Topics
  • Central Nervous System Neoplasms (prevention & control, radiotherapy)
  • Child
  • Cranial Irradiation
  • Humans
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma (pathology)
  • Survival Rate

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