The role of routine surveillance for silent central nervous system relapse in children with acute lymphoblastic leukaemia

摘要

Isolated central nervous system (CNS) relapse of childhood acute lymphoblastic leukaemia (ALL) is uncommon. The cumulative incidence of isolated CNS relapse is 0-6-5% (Pui & Howard, 2008), Risk factors for CNS relapse include T cell immunophenotype, hyperleucocytosis and high-risk genetic abnormalities, such as Philadelphia chromosome (Pui & Thiel, 2009). The prognostic effect of leukaemia cells in the cerebrospinal fluid (CSF) (CNS3, CNS2) or traumatic lumbar puncture with blasts (TLP+) at diagnosis as a risk factor for subsequent CNS relapse varies in different trials (Pui et al, 2009); this probably reflects differences in treatment, such as the use of cranial irradiation and high dose metho-trexate.