Löwenberg Bob, Griffin James D, Tallman Martin S
University Hospital, Erasmus University Medical Center, Department of Hematology, The Netherlands.
Hematology Am Soc Hematol Educ Program. 2003:82-101.
The therapeutic approach to the patient with acute myeloid leukemia (AML) currently evolves toward new frontiers. This is particularly apparent from the entree of high-throughput diagnostic technologies and the identification of prognostic and therapeutic targets, the introduction of therapies in genetically defined subgroups of AML, as well as the influx of investigational approaches and novel drugs into the pipeline of clinical trials that target pathogenetic mechanisms of the disease. In Section I, Dr. Bob Löwenberg reviews current issues in the clinical practice of the management of adults with AML, including those of older age. Dr. Löwenberg describes upcoming possibilities for predicting prognosis in defined subsets by molecular markers and reviews experimental strategies to improve remission induction and postinduction treatment. In Section II, Dr. James Griffin reviews the mechanisms that lead to activation of tyrosine kinases by mutations in AML, the consequences of that activation for the cell, and the opportunities for targeted therapy and discusses some examples of developing novel drugs (tyrosine kinase inhibitors) and their effectiveness in AML (FLT3). In Section III, Dr. Martin Tallman describes the evaluation and management of patients with acute promyelocytic leukemia, a notable example of therapeutic progress in a molecularly defined entity of leukemia. Dr. Tallman focuses on the molecular genetics of APL, current curative treatment strategies and approaches for patients with relapsed and refractory disease. In addition, areas of controversy regarding treatment are addressed.
目前，急性髓系白血病（AML）患者的治疗方法正朝着新的领域发展。这一点从高通量诊断技术的引入、预后和治疗靶点的确定、针对AML基因定义亚组的治疗方法的推出，以及针对该疾病发病机制的研究方法和新药涌入临床试验管道中尤为明显。在第一部分，鲍勃·洛温伯格博士回顾了成人AML临床管理中的当前问题，包括老年患者的问题。洛温伯格博士描述了通过分子标志物预测特定亚组预后的未来可能性，并回顾了改善缓解诱导和诱导后治疗的实验策略。在第二部分，詹姆斯·格里芬博士回顾了AML中因突变导致酪氨酸激酶激活的机制、该激活对细胞的影响以及靶向治疗的机会，并讨论了一些开发新药（酪氨酸激酶抑制剂）的例子及其在AML（FLT3）中的有效性。在第三部分，马丁·塔尔曼博士描述了急性早幼粒细胞白血病患者的评估和管理，这是白血病分子定义实体中治疗进展的一个显著例子。塔尔曼博士专注于APL的分子遗传学、当前的治愈性治疗策略以及复发和难治性疾病患者的治疗方法。此外，还讨论了治疗方面存在争议的领域。
