Blood and Marrow Transplantation Program, Mary Babb Randolph Cancer Center, West Virginia University, PO Box 9162, Morgantown, WV, USA.
Hematol Oncol. 2010 Mar;28(1):3-12. doi: 10.1002/hon.915.
Chemotherapy regimens used for remission induction in AML have not changed significantly over the last several decades. However the recognition of the prognostic value of cytogenetics and genomics has been a major advance which is helping clarify the most optimal post-remission consolidation strategy among various risk groups. We are not only beginning to realize the pitfalls of a 'one-fits-all' approach with intensive, cytarabine-based chemotherapy as the mainstay, but we are finally beginning to reap the rewards of decades of basic, translational, and clinical research. Developing individualized, 'targeted' therapy for each AML patient based on unique molecular features of disease remains a daunting goal yet one that we can now begin to envision. Hypothesis-based study designs-from pre-clinical/laboratory experiments to phase-I and subsequent efficacy trials-provide the foundation for advances in the diagnosis, risk stratification, and treatment for patients with AML. Here we critically review the literature for the management of AML, try to give recommendations regarding the appropriate induction and remission strategy, clarify the role of stem cell transplantation and discuss novel agents on the horizon.
在过去的几十年中，用于 AML 缓解诱导的化疗方案并没有发生重大变化。然而，细胞遗传学和基因组学的预后价值的认识是一个重大进展，有助于阐明各种风险组中最优化的缓解后巩固策略。我们不仅开始意识到以阿糖胞苷为基础的强化化疗作为主要手段的“一刀切”方法的缺陷，而且终于开始收获几十年来基础、转化和临床研究的成果。根据疾病的独特分子特征为每个 AML 患者制定个体化的“靶向”治疗仍然是一个艰巨的目标，但我们现在可以开始设想。基于假设的研究设计——从临床前/实验室实验到 I 期和随后的疗效试验——为 AML 患者的诊断、风险分层和治疗提供了进展的基础。在这里，我们批判性地回顾了 AML 治疗的文献，尝试就适当的诱导和缓解策略提出建议，阐明干细胞移植的作用，并讨论即将出现的新药物。
