Assessment of Magnetic Resonance Imaging of the Brain in Children Cured of Acute Lymphoblastic Leukemia

Treatment success of childhood ALL dramatically improved ALL outcome and changed it from a uniformly fatal disease to one with an overall cure rate greater than 75 %. This therapeutic progress in ALL is the result of treatment advances that began with the identification of effective single agent chemotherapy in the late 1940s, followed by development of combination chemotherapy and maintenance chemotherapy in the 1950s and early 1960s and the implementation of effective central nervous system preventive therapy in the 1960s and 1970s.Initially, cranial radiation was the mainstay of CNS-directed therapy, but this was associated with cognitive impairment. Subsequently, most prophylactic treatment regimens substituted intensified intrathecal and systemic chemotherapy for cranial radiation. Radiation is still used in populations at high risk for CNS disease. CNS-directed therapy can result in leukoencephalopathy, seizures, altered intellectual or psychomotor function, and neurosensory dysfunction.