儿童急性淋巴细胞白血病及其治疗所伴发的中枢神经系统损伤研究进展

doi:10.12372/jcp.2024.23e0892

摘要/Abstract

摘要：

急性淋巴细胞白血病是儿童最常见的恶性肿瘤，急性淋巴细胞白血病伴发的中枢神经系统并发症对患儿预后产生了一定影响。除了肿瘤本身可造成脑损伤外，近来国内外研究者发现抗肿瘤治疗也存在一定的损伤作用。通过对急性淋巴细胞白血病患儿治疗后伴发中枢神经系统损伤的探讨，有助于临床医生早期识别、早期干预并发症，使患儿获得更好的预后和生活质量。

关键词: 中枢神经系统损伤, 急性淋巴细胞白血病, 损伤机制, 儿童

Abstract:

Acute lymphoblastic leukemia (ALL) is the most common malignancy in children, and its central nervous system complications significantly impact the prognosis of children. In addition to the brain damage caused by ALL itself, recent researches have shown that anti-tumor therapy may also result in adverse effects. Investigating central nervous system injury associated with anti-tumor therapy in children with ALL is crucial for early identification and intervention of complications, ultimately leading to improved prognosis and quality of life for children.

Key words: central nervous system injury, acute lymphoblastic leukemia, injury mechanism, child

褚思嘉, 汤继宏. 儿童急性淋巴细胞白血病及其治疗所伴发的中枢神经系统损伤研究进展[J]. 临床儿科杂志, 2024, 42(9): 811-816.

CHU Sijia, TANG Jihong. Research progress of central nervous system injury associated with pediatric acute lymphoblastic leukemia and its treatment[J]. Journal of Clinical Pediatrics, 2024, 42(9): 811-816.

参考文献 42

[1]	彭敏惠, 吴钢. 灾难与重建中的信息力量——急性淋巴细胞白血病患儿家庭信息获取障碍与对策[J]. 图书馆论坛, 2023: 1-10.
[2]	Rahiman EA, Rajendran A, Sankhyan N, et al. Acute neurological complications during acute lymphoblastic leukemia therapy: A single-center experience over 10 years[J]. Indian J Cancer, 2021, 58(4): 545-552. doi: 10.4103/ijc.IJC_422_19 pmid: 34380827
[3]	Deak D, Gorcea-Andronic N, Sas V, et al. A narrative review of central nervous system involvement in acute leukemias[J]. Ann Transl Med, 2021, 9(1): 68. doi: 10.21037/atm-20-3140 pmid: 33553361
[4]	Lenk L, Alsadeq A, Schewe DM. Involvement of the central nervous system in acute lymphoblastic leukemia: opinions on molecular mechanisms and clinical implications based on recent data[J]. Cancer Metastasis Rev, 2020, 39(1): 173-187.
[5]	Swaroop A, Oyer JA, Will CM, et al. An activating mutation of the NSD2 histone methyltransferase drives oncogenic reprogramming in acute lymphocytic leukemia[J]. Oncogene, 2019, 38(5): 671-686. doi: 10.1038/s41388-018-0474-y pmid: 30171259
[6]	Anastasopoulou S, Harila-Saari A, Als-Nielsen B, et al. Does minimal central nervous system involvement in childhood acute lymphoblastic leukemia increase the risk for central nervous system toxicity?[J]. Pediatr Blood Cancer, 2022, 69(7): e29745.
[7]	候威锋, 苏舒, 陈颖茜, 等. 基于集成磁共振成像的急性淋巴细胞性白血病儿童脑体积测量[J]. 中山大学学报(医学科学版), 2023, 44(2): 271-276.
[8]	Anastasopoulou S, Nielsen RL, Als-Nielsen B, et al. Acute central nervous system toxicity during treatment of pediatric acute lymphoblastic leukemia: phenotypes, risk factors and genotypes[J]. Haematologica, 2022, 107(10): 2318-2328.
[9]	Sliwa-Tytko P, Kaczmarska A, Lejman M, et al. Neurotoxicity associated with treatment of acute lym-phoblastic leukemia chemotherapy and immunotherapy[J]. Int J Mol Sci, 2022, 23(10): 5515.
[10]	Pehlivan UA, Gurkan E, Acar IH, et al. Central nervous system neurotoxicity associated with nelarabine in T-cell acute lymphoblastic leukemia[J]. J Oncol Pharm Pract, 2023, 29(1): 246-251.
[11]	Lim KY, Kim SI, Kim H, et al. Toxic leukoencephalopathy with axonal spheroids caused by chemotherapeutic drugs other than methotrexate[J]. Bmc Neurol, 2022, 22(1): 288. doi: 10.1186/s12883-022-02818-8 pmid: 35922754
[12]	席艳丽, 王瑞珠, 徐化凤, 等. 3.0 TMR扩散张量成像对儿童急性淋巴细胞白血病化疗前后认知功能的评价[J]. 临床放射学杂志, 2021, 40(4): 783-789.
[13]	Wang LS, Zou LW, Chen Q, et al. Gray matter structural network disruptions in survivors of acute lymphoblastic leukemia with chemotherapy treatment[J]. Acad Radiol, 2020, 27(3): E27-E34. doi: 10.1016/j.acra.2019.04.010 pmid: 31171463
[14]	Konsman JP, Laaker CJ, Lloyd KR, et al. Translationally relevant mouse model of early life cancer and chemo-therapy exposure results in brain and small intestine cytokine responses: a potential link to cognitive deficits[J]. Brain Behav Immun, 2022, 99: 192-202.
[15]	Wen J, Maxwell RR, Wolf AJ, et al. Methotrexate causes persistent deficits in memory and executive function in a juvenile animal model[J]. Neuropharmacology, 2018, 139: 76-84. doi: S0028-3908(18)30364-2 pmid: 29990472
[16]	Sági JC, Gezsi A, Egyed B, et al. Pharmacogenetics of the central nervous system-toxicity and relapse affecting the CNS in pediatric acute lymphoblastic leukemia[J]. Cancers (Basel), 2021, 13(10): 2333.
[17]	Withrow DR, Anderson H, Armstrong GT, et al. Pooled analysis of meningioma risk following treatment for childhood cancer[J]. JAMA Oncol, 2022, 8(12): 1756-1764. doi: 10.1001/jamaoncol.2022.4425 pmid: 36201196
[18]	Follin C, Erfurth EM. Long-term effect of cranial radiotherapy on pituitary-hypothalamus area in childhood acute lymphoblastic leukemia survivors[J]. Curr Treat Options Oncol, 2016, 17(9): 50.
[19]	Zajac-Spychala O, Pawlak M, Karmelita-Katulska K, et al. Anti-leukemic treatment-induced neurotoxicity in long-term survivors of childhood acute lymphoblastic leukemia: Impact of reduced central nervous system radiotherapy and intermediate- to high-dose methotrexate[J]. Leuk Lymphoma, 2018, 59(10): 2342-2351.
[20]	Newton J, Brown T, Corley C, et al. Cranial irradiation impairs juvenile social memory and modulates hippocampal physiology[J]. Brain Res, 2020, 1748: 147095.
[21]	杨洋, 袁新宇, 王瑶, 等. 儿童异基因造血干细胞移植后可逆性后部白质脑综合征MRI表现[J]. 中国医学影像技术, 2021, 37(6): 810-814.
[22]	Ramanathan S, Subramani V, Kembhavi S, et al. Clinical features, predictors and outcome of posterior reversible encephalopathy syndrome (PRES) in children with hematolymphoid malignancies[J]. Childs Nerv Syst, 2022, 38(9): 1689-1698.
[23]	Zajac-Spychala O, Pawlak MA, Karmelita-Katulska K, et al. Long-term brain status and cognitive impairment in children treated for high-risk acute lymphoblastic leukemia with and without allogeneic hematopoietic stem cell transplantation: a single-center study[J]. Pediatr Blood & Cancer, 2020, 67(6): e28224.
[24]	Mak CYK, Cheuk DKL, Lee PPW, et al. Neurological complications in Chinese children undergoing hematopoietic stem cell transplantation[J]. Childs Nerv Syst, 2021, 37(12): 3753-3767.
[25]	Dreneva AA, Devyaterikova A. Comparative analysis of cognitive, motor, and visual-motor functions in pediatric acute lymphoblastic leukemia survivors with and without allogeneic hematopoietic stem cell transplantation[J]. Arch Clin Neuropsychol, 2022, 37(7): 1493-1501.
[26]	Harrison RA, Sharafeldin N, Rexer JL, et al. Neurocognitive impairment after hematopoietic stem cell transplant for hematologic malignancies: phenotype and mechanisms[J]. Oncologist, 2021, 26(11): e2021-e2033.
[27]	Sakaguchi Y, Natsume J, Kidokoro H, et al. Change of white matter integrity in children with hematopoietic stem cell transplantation[J]. Pediatr Neurol, 2020, 111: 78-84. doi: S0887-8994(20)30199-5 pmid: 32951667
[28]	Xiao X, Huang S, Chen S, et al. Mechanisms of cytokine release syndrome and neurotoxicity of CAR T-cell therapy and associated prevention and management strategies[J]. J Exp Clin Cancer Res, 2021, 40(1): 367. doi: 10.1186/s13046-021-02148-6 pmid: 34794490
[29]	Gust J, Finney OC, Li D, et al. Glial injury in neurotoxicity after pediatric CD19-directed chimeric antigen receptor T cell therapy[J]. Ann Neurol, 2019, 86(1): 42-54. doi: 10.1002/ana.25502 pmid: 31074527
[30]	Shalabi H, Wolters PL, Martin S, et al. Systematic evaluation of neurotoxicity in children and young adults undergoing CD22 chimeric antigen receptor T-cell therapy[J]. J Immunother, 2018, 41(7): 350-358. doi: 10.1097/CJI.0000000000000241 pmid: 30048343
[31]	Rao CK, Kamoroff S, Zorrilla J, et al. Super-refractory status epilepticus during blinatumomab initiation for B-cell acute lymphoblastic leukemia[J]. Immunotherapy, 2022, 14(18): 1437-1442.
[32]	Tang J, Yu J, Cai J, et al. Prognostic factors for CNS control in children with acute lymphoblastic leukemia treated without cranial irradiation[J]. Blood, 2021, 138(4): 331-343. doi: 10.1182/blood.2020010438 pmid: 33684941
[33]	Garcia KA, Cherian S, Stevenson PA, et al. Cerebrospinal fluid flow cytometry and risk of central nervous system relapse after hyperCVAD in adults with acute lymphoblastic leukemia[J]. Cancer, 2022, 128(7): 1411-1417.
[34]	Yu Q, Zhong X, Chen B, et al. Isobaric labeling strategy utilizing 4-plex N, N-dimethyl leucine (D: leu) tags reveals proteomic changes induced by chemotherapy in cerebrospinal fluid of children with B-cell acute lymphoblastic leukemia[J]. J Proteome Res, 2020, 19(7): 2606-2616.
[35]	Lin LP, Su S, Hou W, et al. Glymphatic system dysfunction in pediatric acute lymphoblastic leukemia without clinically diagnosed central nervous system infiltration: a novel DTI-ALPS method[J]. Eur Radiol, 2023, 33(5): 3726-3734. doi: 10.1007/s00330-023-09473-8 pmid: 36882529
[36]	Svärd D, Erfurth EM, Hellerstedt R, et al. Cognitive interference processing in adult survivors of childhood acute lymphoblastic leukemia using functional magnetic resonance imaging[J]. Acta Oncologica, 2022, 61(3): 333-340.
[37]	Song R, Glass JO, Reddick WE. Modified diffusion tensor image processing pipeline for archived studies of patients with leukoencephalopathy[J]. J Magn Reson Imaging, 2021, 54(3): 997-1008. doi: 10.1002/jmri.27636 pmid: 33856092
[38]	Brace KM, Lee WW, Cole PD, et al. Childhood leukemia survivors exhibit deficiencies in sensory and cognitive processes, as reflected by event-related brain potentials after completion of curative chemotherapy: a preliminary investigation[J]. J Clin Exp Neuropsyc, 2019, 41(8): 814-831.
[39]	Li R, Tang JH, Zhang BB, et al. Clinical analysis of childhood acute lymphoblastic leukemia with epilepsy seizures[J]. Front Neurol, 2022, 13: 824268.
[40]	Choi HS, Kim HJ, Kang HJ, et al. Thromboembolism in children with cancer: a retrospective multicenter study in Korea[J]. J Thromb Thrombolysis, 2019, 47(4): 558-565.
[41]	Benkirane A, Mulquin N, London F. Methotrexate-induced stroke-like encephalopathy: Beware the stroke mimic[J]. J Belg Soc Radiol, 2022, 106(1): 98. doi: 10.5334/jbsr.2935 pmid: 36382017
[42]	Kopmar NE, Cassaday RD. How I prevent and treat central nervous system disease in adults with acute lymphoblastic leukemia[J]. Blood, 2023, 141(12): 1379-1388.