Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
Hematology Am Soc Hematol Educ Program. 2009:362-70. doi: 10.1182/asheducation-2009.1.362.
Important studies challenging previous approaches to the treatment of adults with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) have emerged in the past decade. Donor versus no donor comparisons of allogeneic transplant highlight a potent graft-versus-leukemia effect in ALL, and the application of reduced-intensity conditioning transplants may exploit this effect while reducing non-relapse mortality. The adoption of the use of pediatric intensity-type regimens in adolescents and young adults shows promise to improve outcomes in this population. New therapeutic targets such as mutations in NOTCH1 in T-cell ALL and CD22 in pre-B ALL are being exploited in clinical trials. The application of molecular techniques and flow cytometry to quantitate minimal residual disease will allow further stratification of patients by risk. Although the outcomes of adults with ALL lag behind the stunningly successful results seen in children, new paradigms and new discoveries bring hope that this disparity will steadily lessen.
在过去的十年中，出现了一些重要的研究，这些研究对以前治疗费城染色体阴性急性淋巴细胞白血病（ALL）成人的方法提出了挑战。异基因移植中供体与非供体的比较突出了 ALL 中强大的移植物抗白血病效应，而采用强度降低的调理移植可能会利用这种效应，同时降低非复发死亡率。在青少年和年轻成人中采用儿科强度型方案的应用有望改善该人群的预后。新的治疗靶点，如 T 细胞 ALL 中的 NOTCH1 突变和前 B ALL 中的 CD22，正在临床试验中得到利用。分子技术和流式细胞术的应用来定量微小残留病将允许进一步根据风险对患者进行分层。尽管 ALL 成人的预后落后于儿童中令人瞩目的成功结果，但新的范例和新的发现带来了希望，即这种差距将稳步缩小。
