Litzow Mark R
Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
Future Oncol. 2009 Sep;5(7):1039-50. doi: 10.2217/fon.09.74.
Although the outcomes for adults with acute lymphoblastic leukemia (ALL) lag behind the stunningly successful results seen in children, new paradigms and new discoveries bring hope that this disparity will steadily lessen. The adoption of the use of pediatric intensity-type regimens in adolescents and young adults show promise in improving outcomes in this population. Recent donor-versus-no-donor comparisons in the allogeneic transplant setting highlight a potent graft-versus-leukemia effect in ALL, and the application of reduced intensity conditioning transplants may exploit this effect while reducing nonrelapse mortality. New therapeutic targets, such as CD22 in precusor B-cell ALL and mutations in NOTCH1 in T-cell ALL, are being exploited in clinical trials. Finally, use of molecular techniques and flow cytometry to quantitate minimal residual disease will allow further stratifications of patients by risk, identification of new therapeutic targets and will lessen drug toxicity through the use of pharmacogenomics.
尽管成人急性淋巴细胞白血病（ALL）的治疗结果落后于儿童中取得的惊人成功，但新的模式和新发现带来了希望，即这种差距将稳步缩小。在青少年和年轻成人中采用儿科强度类型的方案有望改善该人群的治疗结果。最近在异基因移植环境中进行的有供体与无供体比较突出了ALL中强大的移植物抗白血病效应，而应用降低强度预处理移植可能在利用这种效应的同时降低非复发死亡率。新的治疗靶点，如前体B细胞ALL中的CD22和T细胞ALL中的NOTCH1突变，正在临床试验中得到应用。最后，使用分子技术和流式细胞术定量微小残留病将允许根据风险对患者进行进一步分层、识别新的治疗靶点，并通过使用药物基因组学减少药物毒性。
