Central Nervous System Involvement in Adults with Acute Leukemia: Diagnosis, Prevention, and Management
Purpose of Review Recent treatment advances in both acute myeloid leukemia and acute lymphoblastic leukemia have drastically improved outcomes for these diseases, but central nervous system (CNS) relapses still occur. Treatment of CNS disease can be challenging due to the impermeability of the blood...
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| Veröffentlicht in: | Current oncology reports 2022-04, Vol.24 (4), p.427-436 |
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| creator | Paul, Shilpa Short, Nicholas J. |
| description | Purpose of Review
Recent treatment advances in both acute myeloid leukemia and acute lymphoblastic leukemia have drastically improved outcomes for these diseases, but central nervous system (CNS) relapses still occur. Treatment of CNS disease can be challenging due to the impermeability of the blood–brain barrier to many systemic therapies.
Recent Findings
The diagnosis of CNS leukemia relies on assessment of clinical symptoms, cerebrospinal fluid sampling for conventional cytology and/or flow cytometry, and neuroimaging. While treatment of CNS leukemia with systemic or intrathecal chemotherapy and/or radiation can be curative in some patients, these modalities can also lead to serious toxicities. In the modern era, prophylaxis with intrathecal chemotherapy is the most important strategy to prevent CNS relapses in high risk patients.
Summary
Accurate risk stratification tools and the use of risk-adapted prophylactic therapy are imperative to improving the outcomes of patients with acute leukemias and preventing the development of CNS leukemia. |
| doi_str_mv | 10.1007/s11912-022-01220-4 |
| format | Article |
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Recent treatment advances in both acute myeloid leukemia and acute lymphoblastic leukemia have drastically improved outcomes for these diseases, but central nervous system (CNS) relapses still occur. Treatment of CNS disease can be challenging due to the impermeability of the blood–brain barrier to many systemic therapies.
Recent Findings
The diagnosis of CNS leukemia relies on assessment of clinical symptoms, cerebrospinal fluid sampling for conventional cytology and/or flow cytometry, and neuroimaging. While treatment of CNS leukemia with systemic or intrathecal chemotherapy and/or radiation can be curative in some patients, these modalities can also lead to serious toxicities. In the modern era, prophylaxis with intrathecal chemotherapy is the most important strategy to prevent CNS relapses in high risk patients.
Summary
Accurate risk stratification tools and the use of risk-adapted prophylactic therapy are imperative to improving the outcomes of patients with acute leukemias and preventing the development of CNS leukemia.</description><identifier>ISSN: 1523-3790</identifier><identifier>EISSN: 1534-6269</identifier><identifier>DOI: 10.1007/s11912-022-01220-4</identifier><identifier>PMID: 35141858</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Acute lymphoblastic leukemia ; Acute myeloid leukemia ; Adult ; Blood-brain barrier ; Central Nervous System ; Central Nervous System Neoplasms - diagnosis ; Central Nervous System Neoplasms - prevention & control ; Cerebrospinal fluid ; Chemotherapy ; Cytology ; Diagnosis ; Flow cytometry ; Humans ; Leukemia ; Leukemia (A Aguayo ; Leukemia, Myeloid, Acute - drug therapy ; Leukemia, Myeloid, Acute - therapy ; Lymphatic leukemia ; Medicine ; Medicine & Public Health ; Nervous system ; Neuroimaging ; Oncology ; Patients ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy ; Prophylaxis ; Recurrence ; Risk groups ; Section Editor ; Topical Collection on Leukemia</subject><ispartof>Current oncology reports, 2022-04, Vol.24 (4), p.427-436</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022</rights><rights>2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-9be322aa3f69c4f0d2b0e567b2fb48548a23ea7a0979b45bab9a20921526bcfa3</citedby><cites>FETCH-LOGICAL-c375t-9be322aa3f69c4f0d2b0e567b2fb48548a23ea7a0979b45bab9a20921526bcfa3</cites><orcidid>0000-0002-2983-2738</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11912-022-01220-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11912-022-01220-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35141858$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Paul, Shilpa</creatorcontrib><creatorcontrib>Short, Nicholas J.</creatorcontrib><title>Central Nervous System Involvement in Adults with Acute Leukemia: Diagnosis, Prevention, and Management</title><title>Current oncology reports</title><addtitle>Curr Oncol Rep</addtitle><addtitle>Curr Oncol Rep</addtitle><description>Purpose of Review
Recent treatment advances in both acute myeloid leukemia and acute lymphoblastic leukemia have drastically improved outcomes for these diseases, but central nervous system (CNS) relapses still occur. Treatment of CNS disease can be challenging due to the impermeability of the blood–brain barrier to many systemic therapies.
Recent Findings
The diagnosis of CNS leukemia relies on assessment of clinical symptoms, cerebrospinal fluid sampling for conventional cytology and/or flow cytometry, and neuroimaging. While treatment of CNS leukemia with systemic or intrathecal chemotherapy and/or radiation can be curative in some patients, these modalities can also lead to serious toxicities. In the modern era, prophylaxis with intrathecal chemotherapy is the most important strategy to prevent CNS relapses in high risk patients.
Summary
Accurate risk stratification tools and the use of risk-adapted prophylactic therapy are imperative to improving the outcomes of patients with acute leukemias and preventing the development of CNS leukemia.</description><subject>Acute lymphoblastic leukemia</subject><subject>Acute myeloid leukemia</subject><subject>Adult</subject><subject>Blood-brain barrier</subject><subject>Central Nervous System</subject><subject>Central Nervous System Neoplasms - diagnosis</subject><subject>Central Nervous System Neoplasms - prevention & control</subject><subject>Cerebrospinal fluid</subject><subject>Chemotherapy</subject><subject>Cytology</subject><subject>Diagnosis</subject><subject>Flow cytometry</subject><subject>Humans</subject><subject>Leukemia</subject><subject>Leukemia (A Aguayo</subject><subject>Leukemia, Myeloid, Acute - drug therapy</subject><subject>Leukemia, Myeloid, Acute - therapy</subject><subject>Lymphatic leukemia</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nervous system</subject><subject>Neuroimaging</subject><subject>Oncology</subject><subject>Patients</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</subject><subject>Prophylaxis</subject><subject>Recurrence</subject><subject>Risk groups</subject><subject>Section Editor</subject><subject>Topical Collection on Leukemia</subject><issn>1523-3790</issn><issn>1534-6269</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1v1DAQhi0Eoh_wBzggS1w4NDAe23HMbbUUqLR8SMDZsrOTJSVxip0s6r_H7RaQOHCwbGme950Zv4w9EfBCAJiXWQgrsAIsRyBCpe6xY6Glqmqs7f2bN8pKGgtH7CTnSwAEaOAhO5JaKNHo5pjt1hTn5Af-gdJ-WjL_fJ1nGvlF3E_DnsZS5X3kq-0yzJn_7OdvfNUuM_ENLd9p7P0r_rr3uzjlPp_xT4n2RdFP8Yz7uOXvffS7W5NH7EHnh0yP7-5T9vXN-Zf1u2rz8e3FerWpWmn0XNlAEtF72dW2VR1sMQDp2gTsgmq0ajxK8saDNTYoHXywHsFi2bQObeflKXt-8L1K04-F8uzGPrc0DD5SWc9hjUYZAygL-uwf9HJaUizTFUqBrrVomkLhgWrTlHOizl2lfvTp2glwNzG4QwyuxOBuY3CqiJ7eWS9hpO0fye9_L4A8ALmU4o7S397_sf0FxeySYg</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Paul, Shilpa</creator><creator>Short, Nicholas J.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2983-2738</orcidid></search><sort><creationdate>20220401</creationdate><title>Central Nervous System Involvement in Adults with Acute Leukemia: Diagnosis, Prevention, and Management</title><author>Paul, Shilpa ; Short, Nicholas J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-9be322aa3f69c4f0d2b0e567b2fb48548a23ea7a0979b45bab9a20921526bcfa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Acute lymphoblastic leukemia</topic><topic>Acute myeloid leukemia</topic><topic>Adult</topic><topic>Blood-brain barrier</topic><topic>Central Nervous System</topic><topic>Central Nervous System Neoplasms - diagnosis</topic><topic>Central Nervous System Neoplasms - prevention & control</topic><topic>Cerebrospinal fluid</topic><topic>Chemotherapy</topic><topic>Cytology</topic><topic>Diagnosis</topic><topic>Flow cytometry</topic><topic>Humans</topic><topic>Leukemia</topic><topic>Leukemia (A Aguayo</topic><topic>Leukemia, Myeloid, Acute - drug therapy</topic><topic>Leukemia, Myeloid, Acute - therapy</topic><topic>Lymphatic leukemia</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nervous system</topic><topic>Neuroimaging</topic><topic>Oncology</topic><topic>Patients</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy</topic><topic>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</topic><topic>Prophylaxis</topic><topic>Recurrence</topic><topic>Risk groups</topic><topic>Section Editor</topic><topic>Topical Collection on Leukemia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Paul, Shilpa</creatorcontrib><creatorcontrib>Short, Nicholas J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Biological Science Journals</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Current oncology reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Paul, Shilpa</au><au>Short, Nicholas J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Central Nervous System Involvement in Adults with Acute Leukemia: Diagnosis, Prevention, and Management</atitle><jtitle>Current oncology reports</jtitle><stitle>Curr Oncol Rep</stitle><addtitle>Curr Oncol Rep</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>24</volume><issue>4</issue><spage>427</spage><epage>436</epage><pages>427-436</pages><issn>1523-3790</issn><eissn>1534-6269</eissn><abstract>Purpose of Review
Recent treatment advances in both acute myeloid leukemia and acute lymphoblastic leukemia have drastically improved outcomes for these diseases, but central nervous system (CNS) relapses still occur. Treatment of CNS disease can be challenging due to the impermeability of the blood–brain barrier to many systemic therapies.
Recent Findings
The diagnosis of CNS leukemia relies on assessment of clinical symptoms, cerebrospinal fluid sampling for conventional cytology and/or flow cytometry, and neuroimaging. While treatment of CNS leukemia with systemic or intrathecal chemotherapy and/or radiation can be curative in some patients, these modalities can also lead to serious toxicities. In the modern era, prophylaxis with intrathecal chemotherapy is the most important strategy to prevent CNS relapses in high risk patients.
Summary
Accurate risk stratification tools and the use of risk-adapted prophylactic therapy are imperative to improving the outcomes of patients with acute leukemias and preventing the development of CNS leukemia.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>35141858</pmid><doi>10.1007/s11912-022-01220-4</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2983-2738</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Acute lymphoblastic leukemia Acute myeloid leukemia Adult Blood-brain barrier Central Nervous System Central Nervous System Neoplasms - diagnosis Central Nervous System Neoplasms - prevention & control Cerebrospinal fluid Chemotherapy Cytology Diagnosis Flow cytometry Humans Leukemia Leukemia (A Aguayo Leukemia, Myeloid, Acute - drug therapy Leukemia, Myeloid, Acute - therapy Lymphatic leukemia Medicine Medicine & Public Health Nervous system Neuroimaging Oncology Patients Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy Prophylaxis Recurrence Risk groups Section Editor Topical Collection on Leukemia |
| title | Central Nervous System Involvement in Adults with Acute Leukemia: Diagnosis, Prevention, and Management |
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