Wlewowe leczenie cytarabiną liposomową jako terapia przejściowa przed przeszczepieniem allogenicznych macierzystych komórek krwiotwórczych w drugim izolowanym wznowieniu ośrodkowego układu nerwowego w pediatrycznej białaczce limfoblastycznej komórek B: 15-letnia obserwacja, powikłania neurologiczne i obciążenie leczeniem - opis przypadku i przegląd piśmiennictwa

Central nervous system (CNS) relapse remains a major cause of treatment failure in paediatric acute lymphoblastic leukaemia (ALL). Repeated isolated CNS relapse is particularly rare and associated with poor prognosis, while optimal therapeutic strategies remain insufficiently defined. Intensified CNS-directed therapy may improve disease control but is also associated with substantial long-term neurotoxicity and survivorship burden. We present the case of a boy with favourable-risk B-cell ALL who developed two isolated CNS relapses despite good initial response to frontline therapy and absence of classical CNS relapse risk factors. The second relapse was associated with extensive meningeal involvement and optic nerve infiltration. The patient underwent intensive multimodal CNS-directed therapy including repeated intrathecal chemotherapy, liposomal cytarabine administered according to the IntReALL 2010 protocol, cranial irradiation, and allogeneic hematopoietic stem cell transplantation (alloHSCT) from a matched sibling donor. Durable long-term remission was achieved despite the extremely unfavourable prognosis associated with second isolated CNS relapse. Fifteen-year follow-up extending into early adulthood revealed substantial late complications, including epilepsy, transient ischemic attack, optic nerve injury, endocrinopathies, obesity, secondary thyroid malignancy, neurocognitive difficulties, and depression requiring long-term psychiatric and psychological support. The present case illustrates the complex balance between effective CNS disease control and cumulative treatment-related neurotoxicity in paediatric ALL survivors. It also highlights the cumulative CNS injury and long-term survivorship burden associated with repeated CNS relapse and multimodal CNS-directed therapy.