Rai Kanti R
Division of Hematology/Oncology, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
Semin Oncol. 2006 Apr;33(2 Suppl 5):S15-22. doi: 10.1053/j.seminoncol.2006.01.025.
In the last 10 years purine analogs have become the chemotherapy of choice for the first-line treatment of chronic lymphocytic leukemia, principally because of their superior efficacy compared with alkylating agents. However, many patients experience a relapse after an initial response or become refractory to these agents. The introduction of immunotherapeutic agents has provided renewed hope for fludarabine-refractory patients. Several clinical trials have shown the efficacy of alemtuzumab in patients with fludarabine-refractory chronic lymphocytic leukemia, including those with poor prognostic factors. Current studies indicate that treatment with alemtuzumab can achieve remissions with undetectable residual disease, as assessed by highly sensitive methods such as quantitative polymerase chain reaction or 4-color flow cytometry. These results suggest new applications for alemtuzumab such as combination treatment with chemotherapeutics or immunotherapeutics, maintenance therapy, and in vivo bone marrow purging prior to transplantation. A number of clinical trials are under way assessing the role of alemtuzumab in these settings.
在过去10年中，嘌呤类似物已成为慢性淋巴细胞白血病一线治疗的首选化疗药物，主要是因为与烷化剂相比，它们具有更高的疗效。然而，许多患者在初始缓解后会复发，或对这些药物产生耐药性。免疫治疗药物的引入为氟达拉滨耐药患者带来了新的希望。多项临床试验表明，阿仑单抗对氟达拉滨耐药的慢性淋巴细胞白血病患者有效，包括那些预后不良因素的患者。目前的研究表明，通过定量聚合酶链反应或四色流式细胞术等高度敏感的方法评估，使用阿仑单抗治疗可实现缓解且残留疾病检测不到。这些结果提示了阿仑单抗的新应用，如与化疗药物或免疫治疗药物联合治疗、维持治疗以及移植前的体内骨髓净化。正在进行多项临床试验以评估阿仑单抗在这些情况下的作用。
