In Reply It is well recognized that long-term survivors of childhood acute lymphoblastic leukemia treated without cranial irradiation are still at increased risk for neurocognitive impairment and neuroimaging abnormalities. These outcomes have previously been associated with treatment with intrathecal chemotherapy and high-dose intravenous methotrexate.^1,2 However, these treatments alone could not explain all the variance in neurocognitive outcomes, and other risk factors, such as genetic predispositions, infections, and stroke, have been identified.³ It is important to identify these multiple risk factors to develop interventions for each to improve outcomes. In our recently published study,⁴ we identified exposure to general anesthesia (ie, propofol, fluranes, cumulative duration of anesthesia) as another risk factor associated with neurocognitive impairment in long-term survivors of childhood acute lymphoblastic leukemia. This article has drawn much attention, including the 2 letters by Colquhoun and Mathis and Ishida and Kuratani.

回复众所周知，未经颅脑照射治疗的儿童急性淋巴细胞白血病的长期幸存者仍然面临神经认知障碍和神经影像学异常的风险增加。这些结果以前与鞘内化疗和大剂量静脉注射甲氨蝶呤治疗有关。^{1 ,2}然而，仅这些治疗方法并不能解释神经认知结果的所有差异，并且已经确定了其他风险因素，例如遗传易感性、感染和中风。³识别这些多重风险因素以针对每个风险因素制定干预措施以改善结果非常重要。在我们最近发表的研究中，⁴我们确定暴露于全身麻醉（即丙泊酚、氟烷、累积麻醉持续时间）是与儿童急性淋巴细胞白血病长期幸存者神经认知障碍相关的另一个危险因素。这篇文章引起了很多关注，包括 Colquhoun 和 Mathis 以及 Ishida 和 Kuratani 的 2 封信。