PDF(Pubmed)
Abstract：
Introduction Relapsed acute lymphoblastic leukemia (ALL) involving the central nervous system (CNS) is a significant issue that contributes to both morbidity and mortality. Given the poor outcomes in patients with CNS relapse, understanding how ALL involving intracranial relapse presents and is treated is critical. Here, we present a complex case of relapsed recurrent ALL in a pediatric patient. Case Report An 11-year-old patient presented with double relapse of ALL in the form of an extensive skull base lesion and again with leptomeningeal disease. For the skull base lesion, she was treated nonsurgically with chemotherapy and radiation, which led to a remarkable reduction in the size of the lesion. However, she was found to have early recurrence with leptomeningeal enhancement resulting in hydrocephalus 5 months after completing therapy. A shunt was placed successfully. Currently, she is being managed with monthly intrathecal chemotherapy with cerebrospinal fluid sampling and bone marrow biopsies every 2 months. Discussion We report the significant effect of chemotherapy and radiotherapy in reducing the size of the extensive skull base lesion, saving the patient from the risks associated with surgery. This patient\'s initial relapse, with a large skull base lesion that had intracranial involvement, is an unusual presentation of relapsed ALL. The additional early recurrence of leptomeningeal disease further makes this case unique and the management even more nuanced. Here, we demonstrate a multidisciplinary approach for the successful treatment of our patient, which can help guide the management of similar patients in the future.
摘要：
引言涉及中枢神经系统(CNS)的复发性急性淋巴细胞白血病(ALL)是导致发病率和死亡率的重要问题。鉴于中枢神经系统复发患者的不良预后，了解ALL涉及颅内复发的表现和治疗方式至关重要.这里,我们介绍了1例小儿复发性ALL的复杂病例.病例报告一名11岁的患者以广泛的颅底病变和软脑膜疾病的形式出现ALL的双重复发。对于颅底病变，她接受了化疗和放疗的非手术治疗，这导致病变的大小显著减少。然而,患者在完成治疗5个月后发现早期复发伴脑膜增强,导致脑积水.分流成功。目前,患者接受每月鞘内化疗,每2个月进行一次脑脊液取样和骨髓活检.讨论我们报告了化疗和放疗在减少广泛颅底病变的大小方面的重要作用，将患者从与手术相关的风险中拯救出来。这个病人初次复发,颅内受累的巨大颅底病变，是复发性ALL的不寻常表现。软脑膜疾病的额外早期复发进一步使这种情况变得独特，并且管理更加微妙。这里,我们展示了一种成功治疗患者的多学科方法，这可以帮助指导未来类似患者的管理。
