CONSEQUENCES OF CNS PROPHYLAXIS IN CHILDREN WITH ALL

儿童急性淋巴细胞白血病(ALL)的存活率有 在过去的十年里有了显著的改善。一项重大贡献 成功治疗的特点是引入了中枢神经 系统(中枢神经系统)预防(鞘内甲氨蝶呤和颅脑 辐射)。然而，许多长期幸存者现在被发现 表现出认知缺陷。这种损害通常归因于 发育中的神经系统在发病过程中遭受的损害 治疗。孩子在接受治疗时的年龄显然是 关键因素。现有研究表明，年龄较小的儿童 当接受治疗时，会表现出更严重的缺陷。 这项拟议的研究是对中枢神经系统关系的详细检查 对实施中枢神经系统预防措施的年龄的损害。 具体地说，我们将确定损害的严重性和性质 与治疗年龄、治疗后经过的时间的作用有关，以及 与危及生命的疾病相关的实验因素在 童年。计划进行一项回溯性研究，其中约有100 长期存活的患者将接受详细的神经学和 神经心理评估。 这项研究将提供对中枢神经系统后遗症的详细评估 预防措施。其研究结果将对评估 治疗的相对风险和好处以及在提供适当的 为越来越多的长期幸存者提供咨询和治疗 他们现在表现出重要的认知和行为 困难。此外，这项研究提供了一个独特的机会来获得 洞察人类中枢神经系统发育的正常和异常过程 早年的生活。

Survival rates for children with acute lymphoblastic leukemia (ALL) have been improved dramatically in the last decade. A major contributing feature of successful therapy was the introduction of central nervous system (CNS) prophylaxis (intrathecal methotrexate and cranial irradiation). However, many long-term survivors have now been found to exhibit cognitive deficits. This impairment is generally attributed to damage sustained by the developing nervous system in the course of treatment. The child's age at the time of treatment is apparently a critical factor. Existing studies suggest that children who are younger when treated exhibit more severe deficits. The proposed study is a detailed examination of the relationship of CNS impairment to the age at which CNS prophylaxis is administered. Specifically, we shall determine how the severity and nature of impairment are related to treatment age, the role of time elapsed since treatment, and the role of experimental factors related to life-threatening illness in childhood. A retrospective study is planned in which approximately 100 long-term survivors will receive a detailed neurological and neuropsychological evaluation. This study will provide a detailed assessment of the sequelae of CNS prophylaxis. Its findings will be of considerable value in evaluating the relative risks and benefits of treatment as well as in providing adequate counseling and treatment for the increasing number of long-term survivors who are now presenting with significant cognitive and behavioral difficulties. In addition, the study provides a unique opportunity to gain insight into normal and abnormal processes of human CNS development in the early years of life.