Haematology and Stem Cell Transplantation, Bristol BMT Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Hematology Am Soc Hematol Educ Program. 2010;2010:13-20. doi: 10.1182/asheducation-2010.1.13.
Acute lymphoblastic leukemia (ALL) in adults is a rare disease. The results of therapy remain unsatisfactory, and progress has been relatively slow. This article will focus on curative therapy in patients aged 30 to 60 years, but will also discuss the management of elderly patients with ALL. Recent large trials have increased our knowledge of the factors that determine outcome, and have clarified the role of blood and marrow transplantation in the management of this disease. These trials have also highlighted the major issues we need to focus on if we are to improve outcomes. This article describes the results of chemotherapy and blood and marrow transplantation for Philadelphia chromosome negative and positive adult ALL in the "older" adult patient, but also critically examines the major controversies and suggests how they might be resolved. The role of allografting in adult ALL is comprehensively discussed. Results of recent studies on T-cell ALL and reduced-intensity allografting are reviewed. A better understanding of the biology of the disease (including gene profiling) may allow individualization of therapy and, in time, targeted therapy.
成人急性淋巴细胞白血病（ALL）较为罕见。目前的治疗效果仍不尽如人意，进展也较为缓慢。本文将重点关注 30 至 60 岁成人患者的治愈性疗法，但也将讨论 ALL 老年患者的治疗管理。近期的大型试验增加了我们对决定预后的因素的了解，并明确了血液和骨髓移植在该疾病治疗中的作用。这些试验还突出了我们需要关注的主要问题，以便改善治疗效果。本文描述了化疗和血液与骨髓移植对费城染色体阴性和阳性成人 ALL 的治疗效果，也批判性地探讨了主要争议，并提出了解决这些争议的建议。成人 ALL 中同种异体移植的作用得到了全面讨论。本文还回顾了近期关于 T 细胞 ALL 和减低强度同种异体移植的研究结果。对疾病生物学（包括基因谱分析）的更好理解可能使治疗个体化，并最终实现靶向治疗。
