UCL Hospitals, London, United Kingdom.
Hematology Am Soc Hematol Educ Program. 2009:593-601. doi: 10.1182/asheducation-2009.1.593.
The value of the allogeneic graft-versus-leukemia effect in adult acute lymphoblastic leukemia (ALL) has now been conclusively demonstrated and confirmed. While this is true for adults in all age groups, it may not be the best clinical option for young adults for whom increasingly intensive pediatric protocols are clearly of benefit. On the other hand, there is potentially wider applicability of allogeneic donor transplantation for adults 25 to 45 years old, for whom matched unrelated donors may be as safe and effective as sibling donors, and for the patient older than 45 years for whom reduced-intensity conditioning may be a promising way forward. Since the treatment-related mortality of allogeneic transplantation remains significant, careful selection of patients is mandatory. Patients with the Philadelphia chromosome, those with t(4;11) and those with a complex karyotype remain transplant candidates, and allogeneic transplantation remains the best option for salvage, where achievable, in a remission beyond first. As in childhood ALL minimal residual disease studies may be extremely useful in predicting outcome and, therefore, strategy, but at present there are less definite data in adults. Clinical indications to harness the allogeneic effect will mature as the true value of pediatric protocols in adult patients and the safety and efficacy of a sibling, unrelated and reduced intensity transplant emerge in this disease.
同种异体移植物抗白血病效应在成人急性淋巴细胞白血病（ALL）中的价值现在已经得到了明确的证明和确认。虽然这对所有年龄段的成年人都是如此，但对于年轻人来说，这可能不是最佳的临床选择，因为越来越强化的儿科方案显然对他们有益。另一方面，对于年龄在 25 至 45 岁之间的成年人，同种异体供体移植可能具有更广泛的适用性，对于这些患者，匹配的非亲缘供体可能与亲缘供体一样安全有效，对于年龄大于 45 岁的患者，降低强度的预处理可能是一种有前途的治疗方法。由于同种异体移植的治疗相关死亡率仍然很高，因此必须仔细选择患者。费城染色体阳性、t(4;11)阳性和复杂核型的患者仍然是移植候选者，并且同种异体移植仍然是缓解后第一次缓解以外的挽救治疗的最佳选择。与儿童 ALL 一样，微小残留病研究可能在预测预后和因此的治疗策略方面非常有用，但目前成人的数据并不明确。随着儿科方案在成年患者中的真正价值以及同胞、非亲缘和降低强度移植在这种疾病中的安全性和有效性的出现，利用同种异体效应的临床指征将成熟。
