脑白细胞病,高剂量甲索特雷克萨特治疗骨髓瘤后的常见并发症
Sandra Raimbault1,2, Jean Louis Amegnizin3, Audrey Longaud1
1Department of Children and Adolescent Oncology, Gustave Roussy Cancer Center, Villejuif, France.
Pediatric blood & cancer
|October 22, 2025
概括
甲甲酸相关的白细胞大脑病变在骨髓瘤患者中很常见,经常持续长期. 虽然严重的认知问题很少见,但对于微妙的缺陷,持续监测至关重要.
科学领域:
- 在瘤学瘤学.
- 神经科学是一个神经科学.
- 儿科瘤学 儿科瘤学
背景情况:
- 在骨髓瘤患者中很少报告甲甲酸相关的白内障 (MAL).
- 机构在治疗和随访期间越来越多地通过MRI和神经心理测试监测骨肉瘤患者.
研究的目的:
- 调查骨髓瘤患者中甲铁酸相关的白细胞脑病变的发生率和特征.
- 评估这个患者群体的长期神经认知结果.
主要方法:
- 在OS2006研究中,对接受高剂量甲状腺酸盐 (MTX) 治疗的骨髓瘤患者 (<25岁) 的回顾性分析.
- 纳入标准:>=4个MTX课程和>=1个脑MRI;MTX神经毒性定义为归因于MTX的神经症状.
- 收集的数据包括神经症状,神经成像 (MRI) 和神经认知评估.
主要成果:
- 在符合条件的患者中,有13% (7/53) 患有MTX相关的神经毒性. 在83% (44/53) 的患者中,通过MRI检测出白细胞大脑病变,在患有严重抑郁症或>12个MTX疗程的患者中,2-3级更频繁.
- 在治疗后3年以上的MRI患者中,24名患者中有20名 (83%) 仍然表现出白脑病变 (12级1,8级2).
- 神经认知测试显示智商得分正常,但处理速度降低,治疗后改善. 大多数患者取得了成功的学校/工作融合.
结论:
- 甲甲酸相关的白细胞大脑病变是骨质肉瘤患者的常见发现,包括无症状个体,并且经常在治疗后持续存在.
- 严重的神经认知缺陷似乎不常见,但需要长期监测以确定微妙的认知障碍.
- 这突显了持续监测骨髓瘤幸存者的神经认知影响的重要性,这些幸存者接受了高剂量甲状腺激素治疗.
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