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首页> 外文期刊>World Journal of Oncology >Leptomeningeal Relapse of Acute Promyelocytic Leukemia
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Leptomeningeal Relapse of Acute Promyelocytic Leukemia

机译：急性早幼粒细胞白血病的小脑膜复发

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Extramedullary relapse (EMR) of acute promyelocytic leukemia (APL) is a rare entity, with predilection to involve the central nervous system (CNS). Risk factors include leukocytosis of > 10 × 109/L, bcr3 isoform, microgranular variant, age > 45 years and development of subarachnoid hemorrhage (SAH) during induction therapy. We report a case of APL who completed induction and consolidation therapy but subsequently relapsed with leptomeningeal involvement. Retrospectively, we identified several risk factors for EMR in our patient. Interestingly, the use of all-trans retinoic acid has recently been associated with higher risk of EMR possibly due to up-regulation of adhesion molecules on the surface of the leukemic cell, resulting in their passage through the endothelium to extramedullary tissues. However, data remain conflicting in that regard. Although universal CNS prophylaxis has been suggested, the low incidence of EMR among APL patients renders this strategy less attractive. Nonetheless, active surveillance and CNS prophylaxis may be considered in patients at high risk for EMR, particularly in those of SAH during induction therapy. Further research is needed to evaluate the effectiveness and safety of this strategy. World J Oncol. 2014;5(2):77-80doi: http://dx.doi.org/10.14740/wjon761w
机译：急性早幼粒细胞白血病（APL）的髓外复发（EMR）是一种罕见的实体，易累及中枢神经系统（CNS）。危险因素包括白细胞增多> 10×109 / L，bcr3亚型，微颗粒变体，年龄> 45岁以及诱导治疗期间蛛网膜下腔出血（SAH）的发展。我们报告一例APL患者，该患者完成了诱导和巩固治疗，但随后因累及软脑膜而复发。回顾性地，我们确定了患者EMR的几个危险因素。有趣的是，全反式视黄酸的使用最近与较高的EMR风险有关，这可能是由于白血病细胞表面粘附分子的上调，导致它们穿过内皮到达髓外组织。但是，在这方面数据仍然存在冲突。尽管已建议普遍采用中枢神经系统预防措施，但APL患者中EMR的低发生率使该策略的吸引力降低。但是，对于高EMR风险的患者，尤其是在诱导治疗期间SAH的患者，可以考虑主动监测和CNS预防。需要进一步研究以评估该策略的有效性和安全性。世界J Oncol。 2014; 5（2）：77-80doi：http://dx.doi.org/10.14740/wjon761w

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