INTHRATECAL THERAPY OF ACUTE LYMPHOBLASTIC LEUKEMIA AND NEUROLEUKEMIA IN CHILDREN
Intrathecal therapy (ITT) is an additional therapeutic and prophylactic approach for the treatment of patients with acute lymphoblastic leukemia (ALL) and neuroleukemia (NL) in leukemia treatment evolution. It has performed a reliable option of therapy which may substitute cranial irradiation in high risk patients of ALL, NL, very effectively stopping any NL – initial, preclinical and clinical NL, allow to prevent cumulative risks of development of not only NL, but stem cell relapses, because NL relapses usually may predict common stem cell relapses. Any protocol therapy includes intrathecal therapy elements, which purify CSF very effectively, improving children’s survival with very high results. Only 2.4% – the occurrence rate of NL in original German and international protocols. We used all recommendations of BFM protocol therapy, including cytosis, CNS status, risks. The studied parameters (protein-P, albumin-A, globulines-G, aminonitrogen-Am, neuroactive aminoacids – glutamic acid-GluA, glutamine-Glu in cerebrospinal fluid and serum of blood, N-acetylneuraminic acid – NANA in CSF) and concentration gradients of CSF/ serum for albumin, aminonitrogen, glutamic acid, glutamine in ALL, NL were determined during ALL (status CNS-1): acute period, remission, relapse/recurrence and neuroleukemia (NL): preclinical and clinical variants of NL (CNS-3), initial NL in children (CNS-6) were the same as in the research with radioactive isotopes and neurospecific proteins of CSF, which allow to offer our biomarker panel in pediatric practice. For wider use of the research results there may be recommend NANA as predictor of NL and for early diagnostics of NL, occult NL, and all other types of NL, Am, GluA, Glu – for determination of toxic factor, neurotoxicity, P,A,G – for initial diagnostics of the protein profile of CSF. The concentration gradients may predict possible development of NL (remission, recurrence, lethal NL) in dynamics of observation.
Dzhanybekova IA. Inthratecal therapy of acute lymphoblastic leukemia and neuroleukemia in children. Research Result. Medicine and Pharmacy. 2017;3(3):18-30 (In Russian). DOI: 10.18413/2313-8955-2017-3-3-18-30
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