Abstract：
Steroids are a mainstay in the treatment of acute lymphoblastic leukaemia (ALL) in children and adolescents; however, their use can cause clinically significant steroid-related neuropsychiatric symptoms (SRNS). As current knowledge on SRNS during ALL treatment is limited, we mapped the phenotypes, occurrence and treatment strategies using a database created by the international Ponte di Legno Neurotoxicity Working Group including data on toxicity in the central nervous system (CNS) in patients treated with frontline ALL protocols between 2000 and 2017. Ninety-four of 1813 patients in the CNS toxicity database (5.2%) experienced clinically significant SRNS with two peaks: one during induction and one during intensification phase. Dexamethasone was implicated in 86% of SRNS episodes. The most common symptoms were psychosis (52%), agitation (44%) and aggression (31%). Pharmacological treatment, mainly antipsychotics and benzodiazepines, was given to 87% of patients while 38% were hospitalised due to their symptoms. Recurrence of symptoms was reported in 29% of patients and two previously healthy patients required ongoing pharmacological treatment at the last follow up. Awareness of SRNS during ALL treatment and recommendation on treatment strategies merit further studies and consensus.
摘要：
类固醇是治疗儿童和青少年急性淋巴细胞白血病（ALL）的主要药物；然而，它们的使用可引起临床显著的类固醇相关神经精神症状(SRNS).由于目前在ALL治疗期间对SRNS的了解有限，我们绘制了表型，使用由国际PontediLegno神经毒性工作组创建的数据库，包括2000年至2017年间接受一线ALL方案治疗的患者的中枢神经系统（CNS）毒性数据。CNS毒性数据库中的1813名患者中有94名（5.2％）经历了临床上显着的SRNS，具有两个峰：一个在诱导期间，一个在强化阶段。86％的SRNS发作涉及地塞米松。最常见的症状是精神病（52%），激动（44％）和侵略（31％）。药物治疗,主要是抗精神病药和苯二氮卓类药物，87％的患者因症状住院，而38％的患者因症状住院。29％的患者报告症状复发，两名先前健康的患者在最后一次随访时需要持续的药物治疗。在ALL治疗期间对SRNS的认识和对治疗策略的建议值得进一步研究和共识。
