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[成人急性白血病的当前诊断与治疗方法]

[Current approach to diagnosis and treatment of acute leukemia in adults].

作者信息

Labar Boris, Nemet Damir, Sucić Mate, Batinić Drago, Zadro Renata, Mrsić Sanja, Serventi-Seiwerth Ranka, Sertić Dubravka, Mikulić Mirta, Duraković Nadira

机构信息

Zavod za hematologiju, Klinika za unutrasnje bolesti, Klinicki bolnicki centar, Zagreb, Hrvatska.

出版信息

Acta Med Croatica. 2008 Oct;62(4):403-8.

Abstract

Current classification of acute leukemia is based on morphology, immunophenotyping, cytogenetic and molecular abnormalities of leukemic cells. All these techniques have a diagnostic and prognostic value. Molecular abnormalities in many cases suggest the pathogenesis of acute leukemia, but also point to the key site of genetic abnormalities that may be targeted with the therapy. Treatment approach in acute leukemia is still chemotherapy. The probability of long-term disease-free survival after intensive chemotherapy for younger patients with acute lymphoblastic leukemia and acute myeloid leukemia is 30%-40% and 40%-50%, respectively. Allogeneic stem cell transplantation is associated with better disease-free survival compared to other cytotoxic regimens. In recent years, targeted therapy seems to improve the chemotherapy outcome. This therapy targets only leukemic cells while sparing normal cells. Immunotherapy, differential agents and especially drugs acting on the key molecular abnormalities are currently being used together with chemotherapy as a treatment approach for acute leukemia. It is expected that techniques such as gene expression profiling will identify genetic abnormalities and their proteins as a targeted site for new drugs. This might increase the efficacy of leukemia treatment and control.

摘要

目前急性白血病的分类基于白血病细胞的形态学、免疫表型分析、细胞遗传学和分子异常情况。所有这些技术都具有诊断和预后价值。在许多情况下,分子异常提示急性白血病的发病机制,同时也指出了可能成为治疗靶点的遗传异常关键位点。急性白血病的治疗方法仍然是化疗。对于年轻的急性淋巴细胞白血病和急性髓系白血病患者,强化化疗后长期无病生存的概率分别为30%-40%和40%-50%。与其他细胞毒性方案相比,异基因干细胞移植与更好的无病生存相关。近年来,靶向治疗似乎改善了化疗效果。这种疗法仅针对白血病细胞,而不损伤正常细胞。免疫疗法、分化剂,尤其是作用于关键分子异常的药物,目前正与化疗联合用于急性白血病的治疗。预计基因表达谱分析等技术将识别遗传异常及其相关蛋白,作为新药的靶向位点。这可能会提高白血病治疗和控制的疗效。

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