Chemotherapy-related central nervous system injury in children with acute lymphoblastic leukemia: research progress

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Although therapeutic advances have markedly improved survival, chemotherapy-related central nervous system (CNS) injury is increasingly recognized as a major determinant of neurofunctional outcomes and quality of life. This review summarizes the clinical manifestations, imaging characteristics, and biomarker-based approaches to diagnosing chemotherapy-related CNS injury in children with ALL; outlines drug-induced neurotoxic mechanisms; and discusses current therapeutic and supportive interventions alongside persistent management challenges. There is no standardized, stage-specific care pathway or integrated intervention program at present. Future strategies should align prevention and management with treatment phase and chemotherapy regimen to achieve more precise CNS protection. This review aims to provide information for clinical healthcare professionals to deepen their understanding of the mechanisms, identification, and long-term management of chemotherapy-related CNS injury in children with ALL.