Rambam Health Care Campus and Technion, Israel Institute of Technology, Haifa, Israel.
Br J Haematol. 2010 Aug;150(4):389-405. doi: 10.1111/j.1365-2141.2010.08246.x. Epub 2010 Jun 22.
Treatment of acute lymphoblastic leukaemia (ALL) in adults presents a formidable challenge. While overall results have improved over the past 3 decades, the long-term survival for patients aged less than 60 years is only in the range of 30-40% and is 10-15% if between 60 and 70 years and <5% for those over 70 years. The historic lack of clear-cut biological prognostic factors has led to over- or under-treatment of some patients. Response to initial therapy is an important prognosticator of outcome based on disease biology, as well as pharmacogenetics, which include the patient's response to drugs given. The more widespread availability of allogeneic transplantation and reduced-intensity regimens for older patients have opened up this curative modality to a greater number of patients. Hopefully, those options, as well as novel cytogenetic and molecular markers, will enable a better selection of patients who undergo intensive therapies and finally break the 30-40% cure barrier for adults with ALL.
成人急性淋巴细胞白血病（ALL）的治疗极具挑战性。尽管过去 30 年来整体治疗效果有所改善，但年龄小于 60 岁的患者长期生存率仅为 30-40%，年龄在 60-70 岁之间为 10-15%，年龄大于 70 岁的患者则<5%。历史上缺乏明确的生物学预后因素，导致部分患者治疗过度或不足。根据疾病生物学和药物遗传学，包括患者对所给药物的反应，初始治疗的反应是预后的重要预测因素。随着同种异体移植和老年患者接受减强度治疗方案的广泛应用，这种治疗方式已为更多患者提供了可能。希望这些选择以及新型细胞遗传学和分子标志物能够更好地选择接受强化治疗的患者，并最终打破成人 ALL 患者 30-40%的治愈率障碍。
