Acute lymphoblastic leukaemia (ALL) is the most common malignancy in children. Although the survival rate has increased dramatically over the last decades, patients struggle with the adverse side effects of treatment. Treatment for ALL includes chemotherapy and irradiation - both of which are linked to cognitive impairments and alterations in central nervous system (CNS) structure and function detected by neuroimaging and in neurocognitive studies. The present article is a meta-analysis of the existing evidence for the mechanisms underlying changes in the CNS and neurocognitive function in ALL survivors after treatment. We found that compared with controls, ALL survivors develop: (i) cognitive sequelae in intelligence, academics, attention, memory, processing speed and executive function domains; (ii) decreased grey and white matter volume in cortical and several subcortical brain regions, with functional changes particularly in frontal regions and the hippocampus; (iii) neurocognitive impairments related to CNS changes; and (iv) reduction, but not resolution, of late neurocognitive sequelae in patients in whom prophylactic irradiation was replaced by systemic/intrathecal chemotherapy. Continued work with advanced functional magnetic resonance imaging techniques will hopefully allow the detection of early CNS changes as biomarkers to help guide early diagnosis and intervention for neurocognitive defects in patients with childhood ALL.

中文翻译：

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儿童急性淋巴细胞白血病幸存者治疗后神经认知功能和中枢神经系统结构的变化：一项荟萃分析。

急性淋巴细胞白血病（ALL）是儿童中最常见的恶性肿瘤。尽管在过去的几十年中存活率已大大提高，但患者仍在为治疗带来的不良副作用而苦苦挣扎。ALL的治疗包括化学疗法和放射疗法-两者均与认知障碍以及中枢神经系统（CNS）结构和神经影像学和神经认知研究中检测到的功能改变有关。本文是对治疗后所有幸存者中枢神经系统变化和神经认知功能潜在机制的现有证据进行的荟萃分析。我们发现，与对照组相比，所有幸存者都会发展：（i）智力，学术，注意力，记忆力，处理速度和执行功能领域的认知后遗症；（ii）皮质和大脑皮层下几个区域的灰白物质体积减少，尤其是额叶区域和海马体的功能发生了变化；（iii）与中枢神经系统改变有关的神经认知障碍；（iv）预防性放射被全身/鞘内化疗替代的患者减少了晚期神经认知后遗症，但没有解决。继续与先进的功能磁共振成像技术合作，有望将CNS的早期变化作为生物标记物进行检测，以帮助指导儿童ALL患者的神经认知缺陷的早期诊断和干预。但未通过全身/鞘内化疗替代预防性放射治疗的患者的晚期神经认知后遗症得到解决。继续与先进的功能磁共振成像技术合作，有望将CNS的早期变化作为生物标记物进行检测，以帮助指导儿童ALL患者的神经认知缺陷的早期诊断和干预。但未通过全身/鞘内化疗替代预防性放射治疗的患者的晚期神经认知后遗症得到解决。继续与先进的功能磁共振成像技术合作，有望将CNS的早期变化作为生物标记物进行检测，以帮助指导儿童ALL患者的神经认知缺陷的早期诊断和干预。