Çocuklarda Menenjial Lösemi

Year 1972, Volume: 25 Issue: 5, 943 - 955, 31.10.1972

Sevgi Gözdaşoğlu

Abstract

1963-1972 yılları arasında kliniğimizin hematoloji bölümünde izlediğimiz menenjial lösemi vak'alarını bildirdik.
9 yıllık süre içinde 8i ALL, 45 AMML ve 4 kronik myelositik lösemi olmak üzere toplam 130 hasta izlendi, 130 hastanın 19'unda menenjial lösemi, 5'inde S.S.S infiltrasyonu meydana geldi. Serimizde
S.S.S tutulma oranı 6 18.4 bulundu. Vak'aların 13'ü erkek, 6'sı kızdı. Yaşları 3 yaş-14 yaş arası değişiyordu. Lösemi periferik kan ve kemik iliğiyle teşhis edilmiş, menenjial lösemi ise buna ilâveten
beyin omur sıvısında (B. O. S) hlastların görülmesi ve şimik değişimle tanımlanmıştır.
Vak'aların homojeni olabilmesi için ALL'lerin grup I, AMML'leri grup TI olarak ayırdık. Menenjial lösemi grub I'de lösemi tanısından 5-28 ay ortalama 12.4 ay sonra, grub l1l'de ilk gelişte veya 5 ay
sonra tanımlandı.
Menenjial lösemi, grub Ude 6 hasta tam, 3 hasta parsiyel hematolojik remisyonda, 5 vak'a rölapstayken meydana geldi. Grub 1'de, 3 hastada ilk gelişlerinde, i hastada tam hemtolojik remisyonda, 1 vak'ada ie rölapstayken menenjial lösemi görüldü.
Grub I'de 14 hastanın Yunda baş ağrısı, 12'sinde kusma, ünde fasisal paralizi, 0'er vak'ada konvülsiyon ve strabismus, 3'ünde görme kaybı, (inde yürüme zorluğu dikkati çekti. Ense sertliği, kerning ve Brudzenski 11 hastada müsbetti, Grub 1l'de baş ağrısı, kusma, strabismus 1'er vak'ada fasial paralizi 2 ve şuur kaybı 2 hastada vardı. Menenjial belirtiler (ense sertliği, kerning ve brudzenski) 4 vak'ada müsbet bulundu. Vak'alarımızdan 3 ALL ve 2 AMML''li olmak üzere 5'inde fasial paralizi görüldü. Dört kez menenjial lösemi gösteren ALL'li 7 yaşındaki bir kız çocuğunda hipotalamik sendrom dikkati çekti.
AMML'li hastada conus medullaris ve kauda eguina sendromu tanımlandı. B.0.S'da hücrede hafif bir artma, proteinde artma vardı. Şeker normaldi.
Hastalarımızdan 16'sı İT MTX, 2'si İT MTX ve basa yapılan radyasyonla tedavi edildi. 1 vak'ada ise menenjial lösemi İT MTX, İT Cytosar ve başa uygulanan Cobalt teleterapi ile kontrol altına alınamadı.

Keywords

Lösemi, Menenjit, AMML, KML

Central Nervous System (Meningeal) Leukemia in Children

Abstract

The incidence of CNS leukemia was studied in 130 children who were diagnosed and followed upinour hematology department during the years of 1963 - 1972. The over all incidence was 18.4 96. 19 children had meningeal leukemia and 5 had CNS infiltratlon. The patients varied from 3 to 14 years of age at the time of diagnosis. 13 were boys and 6 were girls. The diagnosis of meningeal leukemia was confirmed by examination of cerebrospinal fluid. The patients were divided into 2 groups according to the type of leukemic celis : Ist group composed of acute Iympfoblastic (ALL) leukemia and the second had acute myelomonocytic variety
Meningeal leukemia first occurred at the times ranging from 5 months to 28 months after the original diagnosis in the Ist group. The median time was 12.4 months, whereas CNS symptoms
were observed either at the time of diagnosis or 5 months after in AMML group.
Ut should be noted that meningeal leukemia occurred in some patients while they were in hematologic remission. One case with ALL had four episodes of meningeal leukemia associated with hypotalamic syndrome. 2 patients with AMML developed «Conus Medullaris» or «Cauda Eguina Syndrome» during the course of their illnesses. The patients were generally treated with intrathecal (IT) methotrexate. A combination of chemotherapy and radiotherapy had to be used in some patients. Only one patient received IT cytosinearabinoside in addition to Cobalt therapy.
The CNS leukemia responded to IT chemotherapy rapidiy. However, they were repeated episodes in some cases.

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