خطر نكس الجهاز العصبي المركزي في مرضى الابيضاض اللمفي الحاد عند البالغين في مشفى المواساة الجامعي

Background & Objective: Relapse of acute lymphoblastic leukemia (ALL) in the central nervous system (CNS) in adults is considered a poor prognostic feature. Few reports have analyzed this issue. The objective of this study was to estimate the experience with CNS recurrence in adult patients with ALL, then to choose the best therapy. Materials & Methods: Between January 2004 and January 2008, the records of 50 consecutive, newly diagnosed patients with ALL, of age above 13 years, who were treated at Almouassat Hospital Center. Patients were treated with published regimen ( LALA-94 ) : ( Vincristine, Doxorubicin, Prednisone and Cyclophosphamide) who achieved complete remission (CR), All patients had received CNS prophylaxis tailored to the risk of CNS .recurrence with systemic chemotherapy with intrathecal (IT) chemotherapy depended on: abnormal lymphocytes or blast lymphocytes in intrathecal fluid. all patients received systemic chemotherapy due to non existence of bone marrow transplantation. ALL-3 was excluded. Results: The median age at the time of diagnosis was 25 years. The median CR duration prior to CNS recurrence was 44 weeks . Three groups were identified: 1) patients with an isolated CNS recurrence (n = 3 patients), 2) patients with CNS recurrences after bone marrow (BM) recurrence (n = 1 patients), and 3) patients with simultaneous CNS and BM recurrences (n = 1 patients). IT chemotherapy was effective in achieving a CNS CR in 3 patients (60%), but 1 patients (20%) had a second CNS recurrence. The median survival from CNS recurrence was7 months; 40% of patients were alive at 1 year. Conclusions: Adults with ALL and CNS recurrences have a poor prognosis despite effective IT chemotherapy. Future studies should investigate better approaches in the treatment of these patients to improve their long-term survival. Effective CNS prophylaxis remains the single best approach for treating patients with CNS leukemia